Part B

SOS Safety Checklist

Instructions:

Low: Tick this box if the situation is assessed as low risk.

Medium: Tick this box if the situation carries some risk.

High: Tick this box if the situation is high risk. Note: If multiple elements are marked as Medium or High, particularly those related to Access to Means, Has a plan, Actualisation and Mental Health History, it is critical to engage support services. If access to support services is not achieved contact emergency services.

Ensure that the individual understands the confidential nature of the information shared and that it is used solely for statistical gathering, their benefit and the improvement of support services. Remind them we do not take personal details, only generic information.

Ideation Time Frame

Have you established the time frame of the individual's suicidal ideation (e.g., recent, ongoing)?

Low

Medium

High

Note time frame of thought, regularity. Houry-Daily- WeeklyDoes the individual indicate any escalation in suicidal thoughts over time?

Low

Medium

High

Comments

Triggers and Stressors

Note-Has there been a recent significant life event (e.g., loss of job, bereavement)?Are there identifiable triggers or stressors (e.g., relationship issues, financial problems)?

Low

Medium

High

Has there been a recent significant life event (e.g., loss of job, bereavement)?

Low

Medium

High

Comments

Mental Health History

Does the individual have a history of mental health issues (e.g., depression, anxiety)?

Low

Medium

High

Note- Yes/ No How many times- How long ago-Have there been any previous suicide attempts?

Low

Medium

High

Comments

Support Systems

Note Support Network- Include with engaging services.Does the individual have access to a strong support system (e.g., family, friends, mental health professionals)?

Low

Medium

High

Note- Contact for engaging servicesIs the individual currently connected with any mental health services or professionals?

Low

Medium

High

Comments

Substance Use

Is there evidence of substance use (e.g., drugs, alcohol) that could impair judgment?

Low

Medium

High

Is substance use affecting the individual's mental state or exacerbating suicidal thoughts?

Low

Medium

High

Comments

Access to Means

Does the individual have access to means of suicide (e.g., firearms, medication)?

Low

Medium

High

Note time frame.Has the individual made any plans or preparations to carry out a suicide attempt?

Low

Medium

High

Comments

Protective Factors

Are there protective factors present (e.g., sense of responsibility to family, future plans)?

Low

Medium

High

Has the individual expressed any willingness to seek help or safety?

Low

Medium

High

Comments

Emotional State

Assess the current emotional state: is the individual calm, agitated, or withdrawn?

Low

Medium

High

Is there a noticeable change in mood or behavior during the conversation?

Low

Medium

High

Comments

Confidentiality and Data Use

Have you informed the individual that the information shared is confidential and only generic information is used for statistical gathering purposes?

Yes

Have you obtained consent for collecting and sharing this data with relevant support services?

Yes

Comments

Encouragement

Have you taken time to congratulate the individual for being courageous and thanked them for sharing with you?

Yes

Have you reminded them about the SOS Stance?

Yes

Comments

Enter Altruist Details

SOS Altruist Full Name

SOS Altruist Email *