Personal Safety Plan Form

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Author: Jefferson County Department of Emergency Managment, WA

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Personal Safety Plan Form 1 id2396

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This "My Personal Safety Plan" form was developed by the Jefferson County Department of Emergency Management and can be filled out with your medication information and emergency contacts to give to your doctor, families, and friends in case of emergency. Accessibility: This form is a Word document that is generally accessible but may be difficult to fill out using a screen reader.

Program: Public Health Preparedness

Submitted Date: Mar 23, 2011 | Modified Date: Sep 30, 2025

Primary Toolkit: Project Public Health Ready (PPHR) Toolkit | Secondary Toolkit: N/A

Jurisdiction:

Institution Type: LHD - County,

Keywords: Vulnerable Populations, Health & Disability

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