1. I will have important phone numbers accessible to my children
and myself:

Police__________________ Hotline_________________ Friends_________________ Shelter_________________

2. I can tell ___________________ and ___________________ about the violence and ask them to call the police if they hear
suspicious noises coming from my home.

3. If I leave my home, I can go (list four places):
________________________________________________
    ________________________________________________
    ________________________________________________
    ________________________________________________

4. I can leave extra money, car keys, clothes, and copies of documents with ________________________.

5. If I leave, I will bring:

• *Identification
• *Mine and my children's birth certificates
• *Social Security cards
• *School and medical records
• *Money, bankbooks, credit cards
• *Keys - house/car/office
• *Driver's license and registration
• *Medications
• Welfare Identification
• Passport(s), Green Card(s), work permits
• Divorce papers
• Lease/rental agreement, house deed, mortgage payment books, current unpaid bills
• Insurance papers
• Address book
• Pictures, jewelry, items of sentimental value, children's favorite toys and/or blankets
  
  (* = most important)
  

6. To insure safety and independence, I can: Keep change for phone calls with me at all times; open my own savings account; rehearse my escape plan with my children and support person and review safety plan on ______________________ (date).
Increasing my safety when the relationship is over

1. I can: Change the locks; install steel/metal doors; a security system; smoke detectors and an outside lighting system.
2. I will inform ___________________ and ___________________ that my partner no longer resides with me and to call the police if s/he is observed near my residence or my children.
3. I will tell people who take care of my children who has permission to pick them up. The people who have permission are: _______________________ and _______________________.
4. I can tell _______________________ at work about my situation and ask _______________________ to screen my calls.
5. I can avoid stores, banks and _______________________ that I used when residing with my battering partner.
6. I can obtain a protective order from _______________________ court, keep it on me at all times as well as a copy with _______________________.
7. If I feel down and ready to return to a potentially abusive situation, I can _______________________ or call for support or attend workshops and support groups to gain support and strengthen my relationships with other people.