Suicide Risk Assessment

Please print this chart and circle the applicable descriptors.

	High	Moderate	Low
Time	Immediately, in progress, within in few hours	Next few days	No specific time, sometime in the future
Details	Very specific; knows how, when, where	Some specifics	Vague, no plans
Method	Has access to identified means (weapon, pills, alcohol) very specific of how, when, where	Uncertain as to access to identified means; some specifics	No method planned or very vague, uncertain plan
Chance of Intervention	No one nearby, no supervision, isolated	Others available, aware and close by	Direct eyeball supervision
Previous Attempts/Gestures	Multiple attempts of moderate lethality, or one of high lethality - in last 6 months	Multiple of low lethality, history of threats - 6 months to one year ago	None or one of low lethality - over a year
Interactions	Minimal interaction and/or estranged/conflictual interactions with significant others and/or interactions are qualitatively different from baseline	One positive connection with significant other and/or interactions are somewhat different from baseline	Frequent positive interactions with one or more significant others, no qualitative change in interactions from baseline

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