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Emotional Safety Plan

Purpose: To help students identify and manage emotional or mental health risks during placement.

Describe your potential emotional triggers or stressors during placement (e.g., high-stress situations, conflicts with staff, sensitive topics):



Strategies to maintain emotional safety (e.g., take short breaks, practice deep breathing, step outside for fresh air, journal feelings):



Supports you will use (e.g., CALCS counsellor, College Field Supervisor, peer mentor, wellness services):

  • College Supervisor / CALCS contact: ___________________________
  • Sponsor, peer or mentor support: ___________________________
  • Wellness or counselling resources: ___________________________

Signs that you need immediate support (e.g., feeling overwhelmed, anxious, unsafe, panic attacks):



Action steps if you feel emotionally unsafe (e.g., call supervisor, leave environment temporarily, contact wellness support):



Notes / Additional Planning:




Travel Safety Plan

Purpose: To help students plan for safe commuting to and from their placement.

Potential travel risks or concerns (e.g., walking alone at night, public transit delays, isolated areas):



Planned travel method(s) (e.g., public transit, ride-share, walking with a classmate, driving own vehicle):



Proactive travel safety strategies (e.g., share location with friend, travel in groups, plan well-lit routes, carry personal alarm or whistle, avoid using headphones):



Safe contacts to reach during travel (e.g., family, friend, College Field Supervisor, agency staff):



Emergency steps if you feel unsafe during travel (e.g., call 911, go to nearest safe public place, contact trusted person, alert College Field Supervisor):



Notes / Additional Planning:



General / Agency Safety Plan

Purpose: To help students manage safety risks within the agency environment and overall placement.

Potential agency risks or concerns (e.g., harassment or inappropriate behaviour from community members or staff, hazardous materials, unsafe physical environment, working alone late):



Planned strategies to maintain safety in the agency (e.g., always inform supervisor when leaving, know exits and safe rooms, maintain boundaries, ask for staff support with high-risk tasks, keep personal items secure):



Contacts and supports for agency-related safety (e.g., Agency Field Supervisor, College Field Supervisor, peer mentor, CALCS counsellor):



Steps to take if you feel unsafe in the agency (e.g., alert supervisor immediately, leave environment if safe to do so, contact College Field Supervisor, document incident, access wellness resources):



Notes / Additional Planning:




Student Name: ___________________________
Program: ___________________________
Placement Agency: ___________________________
Student Signature: ___________________________ Date: __________
College Field Supervisor Signature: ___________________________ Date: __________
Agency Field Supervisor Signature: ___________________________ Date: __________

License

Centennial College Addiction and Mental Health Worker Program (AMHW) Field Placement Manual, 2025–2026 Copyright © 2025 by Michelle Galeotalanza MSW, RSW and Odessa Austin BA, SSW. All Rights Reserved.