PIECE Safety Worksheet
Purpose
Safety means knowing what helps me feel okay in each area of life, knowing my boundaries, and having those boundaries respected.
Physical Safety
Physical safety means my body, space, and belongings are respected.
What feels physically unsafe to me:
What physical distance feels okay:
What touch is okay and not okay:
What I need to protect my space, body, or belongings:
What I want others to do to respect my physical boundaries:
Interpersonal Safety
Interpersonal safety means I feel respected, not pressured, not controlled, and able to choose who has access to me.
What behaviors from other people feel unsafe or disrespectful:
What I need from others to feel safe in relationships:
What I will not accept from other people:
What helps me know when someone is respecting my boundaries:
What I want people to do when I say no or ask for space:
Emotional Safety
Emotional safety means I can have feelings without being shamed, dismissed, judged, or pushed past what I can handle.
What emotions are hardest for me to manage:
What situations tend to overwhelm my emotions:
What helps me stay within my emotional limits:
What I need from others when I am upset:
What I want people to avoid saying or doing when I am emotional:
Cognitive Safety
Cognitive safety means I can think clearly without confusion, pressure, manipulation, or too many demands.
What thoughts or messages make it harder for me to think clearly:
What situations make it hard for me to focus or make decisions:
What helps me slow down and think things through:
What I need from others when I am trying to understand something:
What helps me trust my own thinking and judgment:
Environmental Safety
Environmental safety means my surroundings support predictability, privacy, comfort, and control.
What places, sounds, lights, smells, textures, or other cues make me feel overwhelmed:
What triggers in my environment make things harder for me:
What sensory input helps me feel more settled:
What changes in my environment would help me feel safer:
What I need others to respect about my environment, space, or routine:
What boundaries I have about noise, clutter, interruptions, or access to my space:
My Safety Boundaries
My boundaries are:
What I need people to respect most:
What I will do if a boundary is ignored:
One change I can make this week to support my safety:
Learn more at: https://www.youtube.com/watch?v=BVex1nX1BgM