Intervention Checklist Worksheet

GinaMarie Guarino, LMHC GinaMarie Guarino, LMHC

Worksheet updated on May 29th, 2023

Intervention Checklist

Managing a client in crisis can be challenging for a therapist. When confronted with a situation in which a client is expressing that they are in danger of causing harm to themselves or is in danger of being harmed by someone else, it is important that a therapist does all they can do to keep their client safe.

There are many things to consider when confronted with such a situation. Every situation must be handled delicately and on an individual basis. There are tools that can be used to ensure that a therapist does all they can do for their client.

About This Worksheet

This is the Intervention Checklist worksheet. This worksheet is a tool to use when a therapist is working on a high-risk situation with a client. Some examples of a high-risk situation that a therapist may face with a client include suicidal ideation, intention or desire to harm themselves or others, risk of abuse or domestic violence, and other dangerous situations.

On this worksheet, the therapist is provided with a template of key information to help them develop an intervention plan for the client. The checklist will help the therapist prepare all of the essential information and resources needed to ensure their client’s safety.


It is at the sole discretion of the therapist or clinician when to use this worksheet, and it should only be used as a tool in safety planning and crisis intervention. This worksheet provides a checklist for the therapist to use when creating an intervention plan. To complete the worksheet, fill out the client’s contact information and complete the steps provided. 

This worksheet provides a space for clinical findings, where you can record a summary of your impressions, interventions, and plans for the client’s treatment, along with supervisor approval and notes. Be thorough in your summary of clinical findings. This will help with safety planning and record-keeping. Use this worksheet at your discretion as therapeutic tool and follow up with your supervisor and clinical team as needed.

Download Intervention Checklist Worksheet

Link To This Worksheet

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