[See several printable types of information sheets in Patient Materials.]

Assessing safety
  • Where is your partner now?
  • How safe do you feel returning home today?
  • Do you have a plan for when you don’t feel safe?
  • Has the violence been getting worse, more often, or scarier lately?
  • Has your partner ever choked you, or injured you while you were pregnant?
  • Has your partner ever injured someone outside the home?
  • Has your partner ever injured a pet or destroyed items you cared about?
  • Does your partner have an alcohol or drug abuse problem?
  • Is there a gun in the house?
  • Are the children in danger?
  • Does your partner know you are planning to leave?
  • Has your partner threatened to kill you/him/herself?
[Download danger assessment tool]
Increase safety at home
  • avoid kitchen and bathroom
  • remove gun/weapons from home
  • put a phone in a room you can lock
  • plan an escape route
  • make a signal with neighbors to call the police
Increase children’s safety
  • teach them to call 911 and know their address and phone number
  • make a code word with them to call 911
  • plan an escape route
  • teach them not to get in the middle of a fight
Pack an escape bag for you and children, leave it with a friend
  • clothes
  • money
    • cash, credit & ATM cards
    • change for pay phones
    • checkbook, bank account #s
    • pay stub
  • keys (house, car, office, safety deposit box)
  • medications/glasses
  • phone, phone calling card, address book, hotline numbers
  • toiletries, diapers
  • pictures, keepsakes, toys, books
  • copies of identification and important papers 
    • birth certificates, passports, soc. sec., immigration
    • driver’s license
    • marriage/divorce/custody papers/restraining orders
    • titles, deeds, car registration
    • health insurance cards/important medical records
    • school records/immunization (shot) records
    • journal/photos of abuse
    • photos of abuser to give to school, office security, etc.
 [Adapted from National Center for Victims of Crime and]