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Personal Safety Plan Form


Fill out a "My Personal Safety Plan" form with your medication information and emergency contacts to give to your doctor, families, and friends in case of emergency.

Primary Toolkit:

PPHR Toolkit

Secondary Toolkits:

Health and Disability Toolkit

Keyword Area:

Aging, Disability, Vulnerable Populations


Institutional Author:

Jefferson County Department of Emergency Managment, WA





The NACCHO Toolbox is a repository of available resources to help local public health practitioners. Tools are produced by local, state, and federal agencies, as well as academic institutions and other stakeholders. The contents of this Toolbox are solely the responsibility of the authors and do not necessarily reflect any official recommendations of NACCHO. NACCHO makes no express or implied warranty with respect to the contents and disclaims liability for any damages arising from or connected to the use of the material in this Toolbox.