http://www.ncadv.org/protectyourself/MyPersonalSafetyPlan_131.html
National Coalition Against Domestic Violence
Although one cannot control an abuser's violence, one has a choice about how to respond and how to get to safety. This plan provides victims of domestic violence with steps to increase their safety and prepare to protect themselves in case of further abuse. The plan is a form that helps victims record emergency procedures, names, and numbers.