Historical Factors

Please select all historical factors that apply:

Previous suicide attempt(s) - Date(s):

History of psychiatric diagnosis:

Family history of suicide

History of abuse/trauma

Previous psychiatric hospitalizations - Date(s):

Recent discharge from psychiatric hospital (within past month)

History of impulsivity

History of self-harm behaviors

History of aggression

Current Symptoms

Please select all current symptoms that apply:

Current depression

Current anxiety

Current substance use/intoxication

Current psychosis

Current hopelessness

Current impulsivity

Sleep disturbance

Command hallucinations

Anhedonia

Treatment non-adherence

Stressful Life Events

Please select all stressful life events that apply:

Recent loss/bereavement

Financial problems

Legal problems

Relationship problems/conflict

Job/school problems

Housing instability

Health problems

Humiliating event

Anniversary of traumatic event

Other Risk Factors

Please select all other risk factors that apply:

Access to lethal means:

Chronic pain or physical illness

Social isolation

Poor support system

Minority stress (LGBTQ+, racial/ethnic, etc.)

Barriers to accessing mental health treatment

Other:

Internal Protective Factors

Please select all internal protective factors that apply:

Ability to cope with stress

Religious/spiritual beliefs that prohibit suicide

Responsibility to family/children

Pets

Life satisfaction

Fear of death or dying

Hope for the future

Problem-solving ability

Resilience

Sense of purpose in life

Positive self-esteem

External Protective Factors

Please select all external protective factors that apply:

Social support/connection

Therapeutic relationship

Responsibility to others

Engaged in work or school

Supportive living environment

Active participation in treatment

Limited access to lethal means

Family support

Community resources

Cultural/religious beliefs against suicide

Other:

Suicidal Thoughts

Are you having thoughts of suicide?

Suicidal Thoughts

How often do these thoughts occur?

Suicidal Thoughts

How long do they last?

Suicidal Thoughts

How intense are they?

Suicidal Thoughts

Can you control these thoughts?

Suicidal Intent

Do you want to die?

Suicidal Intent

Do you intend to kill yourself?

Suicidal Intent

What has kept you from acting on your thoughts?

Suicide Plan

Do you have a plan for how to kill yourself?

Suicide Plan

What is your plan?

Suicide Plan

How prepared are you to carry out this plan?

Suicide Plan

Do you have access to the means needed to carry out your plan?

No

Yes

Suicide Assessment Five-Step Evaluation and Triage (SAFE-T)

Instructions

Historical Factors

Please select all historical factors that apply:

Current Symptoms

Please select all current symptoms that apply:

Stressful Life Events

Please select all stressful life events that apply:

Other Risk Factors

Please select all other risk factors that apply:

Internal Protective Factors

Please select all internal protective factors that apply:

External Protective Factors

Please select all external protective factors that apply:

Suicidal Thoughts

Are you having thoughts of suicide?

Suicidal Thoughts

How often do these thoughts occur?

Suicidal Thoughts

How long do they last?

Suicidal Thoughts

How intense are they?

Suicidal Thoughts

Can you control these thoughts?

Suicidal Intent

Do you want to die?

Suicidal Intent

Do you intend to kill yourself?

Suicidal Intent

What has kept you from acting on your thoughts?

Suicide Plan

Do you have a plan for how to kill yourself?

Suicide Plan

What is your plan?

Suicide Plan

How prepared are you to carry out this plan?

Suicide Plan

Do you have access to the means needed to carry out your plan?

Suicide Plan

What steps have you taken to prepare for suicide?

Suicide Assessment Five-Step Evaluation and Triage (SAFE-T)

Instructions

Historical Factors

Please select all historical factors that apply:

Current Symptoms

Please select all current symptoms that apply:

Stressful Life Events

Please select all stressful life events that apply:

Other Risk Factors

Please select all other risk factors that apply:

Internal Protective Factors

Please select all internal protective factors that apply:

External Protective Factors

Please select all external protective factors that apply:

Suicidal Thoughts

Are you having thoughts of suicide?

Previous Next

Suicidal Thoughts

How often do these thoughts occur?

Suicidal Thoughts

How long do they last?

Suicidal Thoughts

How intense are they?

Suicidal Thoughts

Can you control these thoughts?

Previous Next

Suicidal Intent

Do you want to die?

Previous Next

Suicidal Intent

Do you intend to kill yourself?

Previous Next

Suicidal Intent

What has kept you from acting on your thoughts?

Suicide Plan

Do you have a plan for how to kill yourself?

Previous Next

Suicide Plan

What is your plan?

Suicide Plan

How prepared are you to carry out this plan?

Previous Next

Suicide Plan

Do you have access to the means needed to carry out your plan?

Suicide Plan

What steps have you taken to prepare for suicide?