Individual Student Safety Plan

Individual Student Safety Plan
(ISSP)

Written by: [Your Name]

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I. Student Details

A. Student Information

Student Name:

[Student Name]

Date of Birth:

[Date of Birth]

Grade:

[Grade]

School:

[School Name]

Parent/Guardian Name:

[Parent/Guardian Name]

B. Emergency Contact

Name:

[Emergency Contact Name]

Relationship:

[Relationship to Student]

Phone:

[Emergency Contact Phone Number]

C. Health Information

Medical Conditions:

[Any medical conditions]

Medications:

[List of medications]

Allergies:

[Any allergies]


II. Risk Assessment

Primary Concerns

  • History of bullying

  • Social isolation

  • Declining academic performance

Potential Triggers

  • Large group activities

  • Conflict with peers

  • Test anxiety

Protective Factors

  • Supportive family environment

  • Strong relationship with school counselor

  • Interest in extracurricular activities


III. Support Strategies

School-Based Interventions

  • Implement regular check-ins with student counselor.

  • Provide access to support groups or peer mentoring programs.

  • Offer academic accommodations if needed.

Family Involvement

  • Schedule regular meetings with parents/guardians to discuss progress and concerns.

  • Provide resources for family therapy or support services.

Community Resources

  • Refer to external agencies for additional support (e.g., mental health services, social services).


IV. Safety Plan

Warning Signs

  • Withdrawal from social activities

  • Decreased academic performance

  • Expressions of hopelessness

Action Steps

  1. If warning signs are observed, notify designated staff member immediately.

  2. Provide student with a safe space to talk and express feelings.

  3. Contact parent/guardian and emergency contact if necessary.

Crisis Response Protocol

  • Follow school's crisis response procedures in case of emergencies.

De-escalation Techniques

  • Remain calm and empathetic.

  • Use active listening techniques.

  • Provide reassurance and support.

Emergency Contacts

  • Ensure all staff members have access to emergency contact information.

  • Display emergency contact numbers prominently throughout the school.


V. Monitoring and Review

Progress Monitoring

Conduct regular assessments to track progress and adjust support strategies as needed.

Review Meetings

Schedule periodic review meetings with student, parents/guardians, and relevant staff members.

Documentation

Maintain detailed records of interventions, communications, and outcomes.


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