City of Marysville

Name:_______________________ Date:____________

Complaint #:___________ Officer: ______________

The following steps represent my plan for increasing my safety and preparing in advance for the possibility
for further violence. Although I do not have control over my partner's violence, I do have a choice about
how to respond to him/her and how to best get myself and my children to safety.

Step 1: Safety during a violent incident. Victims cannot always avoid violent incidents. In order to increase
safety, battered victims may use a variety of strategies.

I can use some or all of the following strategies:

A. If I decide to leave, I will ___________________. (Practice how to get out safely. What doors, windows, elevators,
stairwells or fire escapes would you use?)
B. I can keep my money and car keys ready and put them (place) _________________ in order to leave quickly.
C. I can tell _____________________about the violence and request they call the police if they hear suspicious noises
coming from my house.
D. I can teach my children how to use the telephone to contact the police and the fire department.
E. I will use _______________________ as my code for my children or my friends so they can call for help.
F. If I have to leave my home, I will go _____________________ (Decide this even if you don't think there will be a next
time).

If I cannot go to the location above, then I can go to_________ __________________
or ______________________________.

G. I can also teach some of these strategies to some/all my children.
H. When I expect we are going to have an argument, I will try to move to a space that is lowest risk,
such as ____________ ____________________. (Try to avoid arguments in the bathroom, garage, kitchen,
near weapons or in rooms without access to an outside door).
I. I will use my judgment and intuition. If the situation is very serious, I can give my partner what he/she wants to calm
him/her down. I have to protect myself until I/we are out of danger.

Step 2: Safety when preparing to leave. Battered victims frequently leave the residence they share with the
battering partner. Leaving must be done with a careful plan in order to increase safety. Batterers often strike back
when they believe that a battered victim is leaving the relationship.

I can use some or all the following safety strategies:

A. I will leave money and an extra set of keys with _____________ so that I can leave quickly.
B. I will keep copies of important documents or keys at _______________________.
C. I will open a savings account by ______________, to increase my independence.
D. Other things I can do to increase my independence include:
E. The domestic violence program's hot line number is 1-800-333-7233 (Marysville Police -911 or 364-6300) and I
can seek shelter by calling this hot line.
F. I can keep change for phone calls on me at all times. I under stand that if I use my telephone credit card, the
following month the telephone bill will tell my batterer those numbers that I called after I left. To keep my telephone
communications confidential, I must either use coins or I might get a friend to permit me to use their telephone credit
card for a limited time when I first leave.
G. I will check with ____________________ and _____________ to see who would be able to let me stay with them
or lend me some money.
H. I can leave extra clothes with _________________________.
I. I will sit down and review my safety plan every ______________ in order to plan the safest way to leave the residence.
_____________ (domestic violence advocate or friend) has agreed to help me review this plan.
J. I will rehearse my escape plan and, as appropriate, practice it with my children.

Step 3: Safety in my own residence. There are many things that a victim can do to increase her/his safety in their
own residence. It may be impossible to do everything at once, but safety measures can be added step by step.

Safety measures I can use include:

A. I can change the locks on my doors and windows as soon as possible.
B. I can replace wooden doors with steel/metal doors.
C. I can install security systems including additional locks, window bars, poles to wedge against doors, an electronic
system, etc.
D. I can purchase rope ladders to be used for escape from second floor windows.
E. I can install smoke detectors and purchase fire extinguishers for each floor in my house/apartment.
F. I can install an outside lighting system that lights up when a person is coming close to my house.
G. I will teach my children how to use the telephone to make a collect call to me and to _______________
(friend/minister/ other) in the event that my partner takes the children.
H. I will tell people who take care of my children which people have permission to pick up my children and that my
partner is not permitted to do so. The people I will inform about pick-up permission include:
__________________________________________(school),
________________________________________(day care staff),
________________________________________(babysitter),
___________________________________(Sunday school teacher),
________________________________________(teacher),
________________________________________(and),
________________________________________(others),
I. I can inform ______________________________(neighbors),
_______________________________________(pastor), and,
_______________________________________(friend) that my partner no longer resides with me and they should
call the police if he is observed near my residence.

Step 4: Safety with an Order of Protection. Many battered victims obey protection orders, but one can never be
sure which violent partner will obey and which will violate protection orders. I recognize that I may need to ask the
police and the court to enforce my protection order.

The following are some steps that I can take to help the enforcement of my protection order:

A. I will keep my protection order _________________(location) (Always keep it on or near your person).
B. I will give my protection order to police departments in the communities where I usually visit family or friends, and
in the community where I live.
C. There should be a county registry of protection orders that all police departments can call to confirm a protection
order. I can check to make sure that my order is in registry. The telephone number for the county registry of protection
order is _________________________________.
D. For further safety, if I often visit other counties in Tennessee, I might file my protection order with the court in those
counties. I will register my protection order in the following counties:

___________________ and _________________ that I have a protection order in effect.

E. I can call the local domestic violence program if I am not sure about B, C, or D above or if I have some problem with
my protection order.
F. I will inform my employer, my minister, my closest friend and _____________ and ____________that I have a
protection order in effect.
G. If my partner destroys my protection order, I can get another copy from the St. Clair County Courthouse by going
to the Circuit Court Clerk's office on the 2nd floor of the St. Clair County Building at 201 McMorran Blvd., Port Huron.
H. If my partner violates the protection order, I can call the police and report a violation, contact my attorney, call my
advocate, and/or advise the court of the violation.
I. If the police do not help, I can contact my attorney and will file a complaint with the chief of the police department.

Step 5: Safety on the job and in public. Each battered victim must decide if and when he/she will tell others that
their partner has battered them and that he/she may be at continued risk. Friends, family and co-workers can help to
protect victims. Each victim should consider carefully which people to invite to help secure his/her safety.

I might do any or all of the following:

A. I can inform my boss, the security supervisor and ___________ at work of my situation.
B. I can ask ________________ to help screen my telephone calls at work.
C. When leaving work, I can ______________________________ __________________________________________.
D. When driving home if problems occur, I can ________________ _________________________________________.
E. If I use public transit, I can ______________________________ _________________________________________.
F. I will go to different grocery stores and shopping malls to conduct my business and shop at hours that are different
than those when residing with my battered partner.
G. I can use a different bank and take care of my banking at hours different from those I used when residing with my
battered partner.
H. I can also __________________________________________.

Step 6: Safety and drug or alcohol use. Most people in this culture use alcohol. Many use mood-altering drugs.
Much of this use is legal and some is not. The legal outcomes of using illegal drugs can be very hard on a battered
victim, may hurt his/her relationship with their children and put him/her at a disadvantage in other legal actions with the battering partner. Therefore, victims should carefully consider the potential cost of the use of illegal drugs. But beyond this, the use of any alcohol
or other drug can reduce a victim's awareness and ability to act quickly to protect themselves from the battering partner. Furthermore, the use of alcohol or other drugs by the batterer may give him/her an excuse to use violence. Therefore, in the context of drug or alcohol
use, a victim needs to make specific safety plans.

If drug or alcohol use has occurred in my relationship with the battering partner, I can enhance my safety by some or
all of the following:

A. If I am going to use, I can do so in a safe place and with people who understand the risk of violence and are
committed to my safety.
B. I can also ___________________________________________.
C. If my partner is using, I can _____________________________.
D. I might also _________________________________________.
E. To safeguard my children, I might ________________________
and ______________________________________________.

Step 7: Safety and my emotional health. The experience of being battered and verbally degraded by partners is
usually exhausting and emotionally draining. The process of building a new life for myself takes much courage and
incredible energy.

To conserve my emotional energy and resources and to avoid hard emotional times, I can do some of the following:

A. If I feel down and ready to return to a potentially abusive situation, I can___________________________________.
B. When I have to communicate with my partner in person or by telephone, I can______________________________.
C. I can try to use "I can . . . " statements with myself and to be assertive with others.
D. I can tell myself - "_____________________________________ ______________________________" whenever
I feel others are trying to control or abuse me.
E. I can read ____________________________to help me feel stronger.
F. I can call ___________________, ___________________ and _________________as other resources to be of
support of me.
G. Other things I can do to help me feel stronger are ____________ ______________, and ______________________.
H. I can attend workshops and support groups at the domestic violence program or _________________________, or
_____ _______________to gain support and strengthen my relationship with other people.

Step 8: Items to take when leaving. When victims leave partners, it is important to take certain items with them.
Beyond this, victims sometimes give an extra copy of papers and an extra set of clothing to a friend just in case they
have to leave quickly.

Money : Even if I have never worked, I can legally take 1/2 of the funds in the checking and savings accounts as
Michigan is a community property state. If I don't take any money from the accounts, he/she can legally take all
money and/or close the account and I may not get my share until the court rules on it if ever.

Items with asterisks on the following list are the most important to take. If there is time, the other items might be
taken, or stored outside the home.

These items might be placed in one location, so that if we have to leave in a hurry, I can grab them quickly.

When I leave, I should have:

* Identification for myself
* Children's birth certificate
* My birth certificate
* Social security cards
* School and vaccination records
* Money
* Checkbook, ATM (Automatic Tellers Machine) card
* Credit cards
* Keys - house/car/office
* Driver's license and registration
* Medication
* Welfare identification, work permits, Green card
* Passport(s), Divorce papers
* Medical records - for all family members
* Lease/rental agreement, house deed, mortgage payment book
* Bank books, Insurance papers
* Small saleable objects
* Address book
* Pictures, jewelry
* Children's favorite toys and/or blankets
* Items of special sentimental value

Telephone numbers I need to know:

Police department - home - 911
St. Clair Country Prosecuting Attorney's Office -985-2400
Police department - school _____________________________
Police department - work ______________________________
Dares Shelter 985-4950(Business) or 985-5538 (Crisis) __________
County registry of protection orders ______________________
Work number________________________________________
Supervisor's home number_____________________________
Minister____________________________________________
Other______________________________________________

I will keep this document in a safe place and out of the reach of my potential attacker.

Review date:_________________________

IF YOU NEED HELP IN FILLING OUT THIS PLAN YOU MAY ASK THE MARYSVILLE POLICE DEPARTMENT,
COUNSELORS, DARES SHELTER WORKER, THE PROSECUTING ATTORNEY'S VICTIM WITNESS OFFICE
PERSONNEL OR A CLOSE AND TRUSTED FRIEND.