Checklist You Are Not Alone
These items may be good to have if I
decide to leave:
__Drivers license Rose Brooks Center helps people
__Birth certificates & SSN #’s
who have been impacted by domestic
violence. Rose Brooks Center offers You Have
__Bank books/ Checkbooks
free shelter, support, counseling, and
advocacy services. the Right
to Be Safe
__Social Security benefits/payee info. 24-hr Domestic Violence Hotline:
__Welfare information 816.861.6100
LEGAL PAPERS Is someone hurting you?
__MY ORDER OF PROTECTION MOCSA helps people who have been
__Lease, rental agreement, deed
Do you feel unsafe?
impacted by sexual abuse or assault.
__Car registration & insurance papers MOCSA offers free support, counseling, We can help.
__Health & Life insurance papers advocacy, & education services.
__Medical records MOCSA’s 24-hr Crisis Line:
__School records 816.531.0233
__Work permits/Green card/VISA Rose Brooks Center
__Marriage/Divorce/Custody papers Institute for Human Development 24-hr Domestic Violence Hotline:
OTHER (IHD) provides support and referrals to 816.861.6100
__House & car keys services for people with disabilities.
__Medication, medical information, Contact IHD during business hours: Metropolitan Organization to
medical supplies/medic alert system 816.235.1770 Counter Sexual Assault (MOCSA)
__Phone numbers of emergency TTY: 800.452.1185 24-hr Sexual Violence Crisis Line:
medical & support personnel 816.531.0233
__Assistive devices (i.e. hearing aids, This project was supported by Grant No. 913.642.0233
oxygen tanks, glasses, batteries, etc) 2006-FW-AX-K014 awarded by the Office on
__Supplies for service animal Violence Against Women, U.S. Department of
MO Relay: 800.735.2966
__Address books Justice.
__Toiletries & change of clothes IN CASE OF EMERGENCY CALL: 911
What is a Safety Plan? Planning for Safety
It is a plan that you have in your head Here are some ideas that could help I can have the locks changed on my
or that you have written down on me stay safe. I can use the ideas that doors & windows or ask my landlord
paper that is made to keep you safe work for me. to change them.
or as safe as possible. This plan is a Remember: I DO NOT DESERVE TO BE
first step. An advocate can help you HURT OR FEEL AFRAID! I can have _____________________
to plan more and find resources. Your check in on me every ____________.
safety plan can change as things in During a fight, I will try to be close
your life change. to an exit. I will try to stay away from I can__________________________
anywhere where guns or knives are ______________________________
kept. to increase my mobility.
When to Use a Safety Plan
• When you feel afraid for your I can practice how to get out of my If I have a protection order, I can tell
safety. home safely. family, friends, neighbors, teachers
• When someone is hurting you. and my doctor or health care provider
• When someone tells you they I will identify a safe friend I can tell that the order is in place.
want to hurt you. about the abuse and ask them to call
• When you are being abused. the police if they hear fighting coming At work I can decide who I will tell
• When someone who abuses you from my home. about my situation. This may be
still lives, works or contacts you. building security. Give a picture of
• For keeping yourself safe after you I will pre-register with the 911 call ____________________ if possible.
have ended your relationship with center to share disability related
someone who is abusive. information that would be helpful for If I am feeling down, lonely or
• When someone is stalking you. first responders. confused, I can call _______________
• When someone has forced you to or I can attend a support group at
have sex or do something sexual In case I need to leave I will have a _____________________________.
when you did not want to. packed bag ready and keep it at a safe
person’s home so I can leave quickly. I can ask a friend that knows about
computers how my abuser may find
I can make a plan for where I will go information about me.
if I have to leave home. I will tell them
about any needs I may have.