Safety Planning
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1. Default Section
1
. Did you complete a safety plan with a staff member of Teton County Victim Services?
Did you complete a safety plan with a staff member of Teton County Victim Services?
Yes
No
2
. Did you understand the safety planning process?
Did you understand the safety planning process?
Yes
No
3
. Have you ever completed a safety plan before?
Have you ever completed a safety plan before?
Yes (How long ago and with what agency?)
No
Date & Agency
4
. Was part of your safety planning due to a request to drop a "no contact order", domestic violence or stalking protection order?
Was part of your safety planning due to a request to drop a "no contact order", domestic violence or stalking protection order?
Yes
No
If yes, what type? DV or Stalking
5
. Was requesting extra patrol by law enforcement part of your plan?
Was requesting extra patrol by law enforcement part of your plan?
Yes
No
6
. Did your safety planning address any of the following?
Did your safety planning address any of the following?
Assistance with shelter or housing?
Help with child care or visitation?
Help with obtaining a protection order?
Help obtaining legal documents such as social security cards, birth certificates, marriage certificate, etc?
Information on Community Safety Network?
7
. I know more ways to plan for my safety.
I know more ways to plan for my safety.
Yes
No
Other (please specify)
8
. Do you feel you were listened to and your input was considered when creating your safety plan?
Do you feel you were listened to and your input was considered when creating your safety plan?
Yes
No
9
. Do you feel confident that if you need to enact this safety plan, you will be able to?
Do you feel confident that if you need to enact this safety plan, you will be able to?
Yes
No
If no, what would be helpful to assist you?
10
. In the future if you feel you are in danger, will you call law enforcement again to assist you?
In the future if you feel you are in danger, will you call law enforcement again to assist you?
Yes
No
If no, can you tell us why?
11
. Are you:
Are you:
Male
Female
12
. Your age is:
Your age is:
Under 18
18-25
26-30
31-35
36-40
41-45
46-50
51-55
56-60
60+
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