Safety planning screen — not stored
Confidential conversation
IPV, domestic abuse, and trafficking screen
Original prompts aligned to the Housing Services Act definition of abuse and trafficking. This is not the Danger Assessment, HITS, WAST, or any scored clinical instrument. Use your agency’s mandated tool when required. Conduct this privately. Never with the alleged abuser present.
If someone is in immediate danger, stop the form and call 911.
Assaulted Women’s Helpline: 1-866-863-0511 (TTY 1-866-863-7868).
Human Trafficking Helpline: 1-833-999-9211.
Kids Help Phone: 1-800-668-6868.
Talk4Healing (Indigenous women): 1-855-554-4325.
Summary will appear here
Generate, then print. Closing the tab destroys the answers.
After a disclosure
- Believe the person. Do not ask “why didn’t you leave.”
- Offer SPP + RGI and VAW / trafficking programs as parallel tracks.
- Safety plan: documents, keys, medications, children’s items, safe contact, device security.
- Duty to report only where child-protection or other mandatory-report statutes apply. Explain limits of confidentiality first when you can.
- Code grounds often stacked: sex, family status, disability, citizenship, creed, race.