The C-SSRS asks up to six plain questions about suicidal thoughts in the past month and suicidal behavior, and the highest yes sorts the answers into low, moderate, or high risk. See what each question covers, how the risk levels work, and where to get the official form, then record the result with the free template.
C-SSRS result template
FreeC-SSRS SCREEN Screen date and time: [Date, time] Patient: [Name or record number, age] Setting: [Emergency department, inpatient unit, clinic, telehealth, or other] Asked by: [Name, role] Version used: [Screener recent, screener since last contact, full scale lifetime and recent, or since last visit] Language: [Language used; interpreter name or ID if one helped] Why screened: [Universal screen, positive depression item, concern raised by patient or family, or repeat check] ANSWERS Timeframe: [Past month for thoughts, lifetime and past 3 months for behavior; or since last contact] Questions asked: [Which questions were asked, following the official skip pattern] Answered yes: [Question numbers answered yes, in the patient's words where useful] Behavior: [None, lifetime only, or within the past 3 months; what happened and when] Highest yes: [0 to 6] RISK LEVEL Screen result: [None, low, moderate, or high] Basis: [The answer that set the level, and its timing] Clinician review: [Who reviewed the screen, and whether a full risk assessment followed] ACTIONS TAKEN Safety plan: [Made, reviewed, or not indicated] Means safety: [Firearms, stored medicines, and other means discussed; who is securing them] Referral: [Behavioral health referral or consult, with date] Emergency evaluation: [Not needed, or arranged: where, how the patient got there, observation level] Crisis contacts: [988 by call or text, and local crisis services given] WHO WAS TOLD Care team: [Nurse, physician, or behavioral health clinician informed, with the time] Family or support person: [Who, with the patient's agreement, or the reason it was done without it] Next screen: [When the next C-SSRS is due, and which version] Signed: [Name, credentials]
Use it for
Columbia publishes short screeners for triage and a full scale for detailed assessment, in recent, lifetime, and since-last-contact forms, with versions for specific settings.
Avoid: Writing your own version of the questions into a form or the record. The core questions are fixed; download the official version.
Ask them as written, somewhere private, in a calm and direct voice. Columbia says no mental health training is needed to ask them.
Avoid: Softening the words into “You’re not thinking of hurting yourself, are you?” A leading question invites a no.
The highest question answered yes, and when any behavior happened, set the level.
Avoid: Lowering the level because the patient says they feel better now. Record the answers as given, then add your own view beside them.
Each organization sets what follows each level. The usual pattern rises with the risk.
Avoid: Ending at the screen. A moderate or high result starts a full suicide risk assessment; it doesn’t replace one.
Recheck with a since-last-contact version, so each screen covers the time since the last one.
Each one follows the recording template. Use them to judge how much to write.
Emergency department, universal screen by the triage nurse, screener recent with triage points
52-year-old man brought in by his sister for not eating or sleeping since his business closed. Asked in a private room, in English. Yes to questions 1 to 4: he wishes he were dead, has thought of killing himself most days this month, has thought of taking his stored oxycodone, and says he would act on it “if nothing changes.” No to question 5: no worked-out plan. No to question 6, lifetime. Highest yes: 4, past month.
High risk: question 4, intent, within the past month. The emergency physician saw him within 15 minutes and agreed with the level.
Moved to a safe room; belongings searched and secured; constant observation by a sitter. Full suicide risk assessment by the physician and the psychiatry consult team. His sister removed the oxycodone and his hunting rifle from his home and confirmed both are locked at her house. Psychiatry recommended voluntary admission; he agreed, and a bed was requested on the psychiatric unit.
Charge nurse and emergency physician told at 14:10, at the screen. Psychiatry paged at 14:25. His sister told of the plan, with his agreement. Next screen: since-last-contact version each shift while he is in the department.
Student health clinic, follow-up visit, screener recent on the check-in tablet
24-year-old graduate student. Yes to questions 1 and 2: she has wished she could disappear and had brief thoughts of killing herself on two nights this month, during exams. No to questions 3, 4, and 5: no method, intent, or plan. No to question 6: no suicidal behavior ever. Highest yes: 2.
Low risk: question 2, past month, nothing higher. The nurse practitioner went through it at the same visit: the thoughts are fleeting, come late at night, and pass by morning. No past attempts. She lives with two roommates and talks to her sister daily.
Safety plan written together: her warning signs, a run or a call to her sister, the campus counseling center, and 988 by call or text. Means safety: no firearms; only a small bottle of ibuprofen at home. Referral to counseling, first appointment Thursday. Clinic follow-up in 2 weeks.
The medical assistant told the nurse practitioner before the visit began. She chose not to involve family for now; her sister is on the safety plan as a contact. Next screen: since-last-contact version at the 2-week visit.
Gentler words change what the questions find, and the core questions may not be altered. Read them as written from the official form.
Question 6 is asked even when question 2 is no. Someone with no thoughts today can still have made an attempt last month, which is high risk.
An attempt last month and one 10 years ago lead to different levels. Ask whether it was within the past 3 months, and write the date.
Record which questions were yes, the timeframe, and the level, so the next clinician knows what was found and what was done.
Every level above none needs the response your organization has set, and a moderate or high result leads to a full suicide risk assessment.
Vero Scribe records the C-SSRS result in your template from the visit, with the patient’s consent, or from your dictation: the questions answered yes, the timeframe, the risk level, and what you did. You review and edit every line, then copy it into your record. Vero works in 60+ languages.
The screener has no total. Note the highest question answered yes and, for question 6, whether the behavior was within the past 3 months. Question 1 or 2 alone is low risk; question 3, or behavior longer ago, is moderate; question 4, 5, or behavior in the past 3 months is high. The full scale adds ratings of how intense the thoughts are and how lethal any attempt was.
Low risk is a wish to be dead or general thoughts of suicide, without a method, intent, plan, or recent behavior. Moderate risk adds thoughts about a method, or behavior more than 3 months ago. High risk is intent, a plan with intent, or behavior in the past 3 months. Each organization decides what it does at each level; high risk usually means staying with the person and an emergency evaluation.
Columbia counts any high-risk answer as positive: yes to question 4 or 5 in the past month, or suicidal behavior in the past 3 months. Most organizations also respond to low and moderate answers, with a safety plan, means safety, and a referral.
The screener asks 2 to 6 questions, depending on the answers, and is used for triage. The full scale adds intensity ratings and attempt details, in lifetime and recent, baseline, and since-last-visit forms. There are versions for emergency departments, inpatient units, primary care, schools, and corrections, versions for young children, and translations in more than 100 languages.
PHQ-9 item 9 is one question about thoughts of death or self-harm, inside a depression questionnaire. The C-SSRS asks only about suicide, separates thoughts, method, intent, plan, and behavior, and gives a risk level. Many clinics follow a positive item 9 with the C-SSRS.
Columbia says anyone can ask the questions and no mental health training is needed: nurses, physicians, medical assistants, counselors, teachers, and first responders all use it. Free training is on the Columbia Lighthouse Project site. A clinician makes the full risk assessment and plan that follow a moderate or high result.
Yes, in healthcare and community settings and in nonprofit or publicly funded research, with no special permission needed. Download the official version for your setting, and its translations, from the Columbia Lighthouse Project, and don’t change the core questions. The recording template on this page is free to copy or download.
Nine questions on the last two weeks: depression screening and severity, scored 0 to 27.
Two questions on interest and mood: a quick first screen for depression, scored 0 to 6.
Seven questions on worry and tension: anxiety screening and severity, scored 0 to 21.
Twenty items on the past month: PTSD screening and symptom tracking, scored 0 to 80.
Ten self-report items on the past 7 days: depression screening in pregnancy and after birth, scored 0 to 30.
For a moderate or high screen: ideation, intent, means, risk and protective factors, and the formulation.
Warning signs, coping steps, contacts, and means safety, written with the patient.
Evaluations and follow-ups written from the visit, in your templates.
Every tool, by area, with what its scores mean.
Vero records scores, findings, and plans in the templates you choose, so you review instead of type.
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