A suicide risk assessment is the clinician’s documented judgment after a positive screen or a disclosure: what the person is thinking, planning, and facing, and what you will do about it. Copy the free template, see a primary care example and an emergency department example, and check what to write in each part, from lethal means to the risk formulation.
Blank suicide risk assessment template
FreeSUICIDE RISK ASSESSMENT Patient: [Name, age] Date and time: [Date and time of assessment] Setting: [Primary care, outpatient, emergency department, inpatient, or telehealth; patient's location if remote] Clinician: [Name, credentials] Sources: [Patient, family or others, records, other clinicians] REASON FOR ASSESSMENT Why now: [Positive screen, disclosure, self-harm or attempt, or concern raised by others] Screening result: [Tool and result, such as the ASQ, the C-SSRS screener, or PHQ-9 item 9] Patient's account: [What is happening, in the patient's words] SUICIDAL IDEATION Type: [Wish to be dead, or active thoughts of ending one's life] Onset and frequency: [When the thoughts began and how often they come] Intensity and duration: [How strong, how long they last, how hard they are to set aside] Change: [Better, worse, or the same as the patient's usual] Reasons for dying and for living: [In the patient's words] PLAN, INTENT, AND PREPARATION Plan: [Method, place, and timing, and how far worked out] Intent: [How much the patient means to act, and what they expect would happen] Preparatory behavior: [Getting means, researching methods, notes, goodbyes, giving things away] Aborted or interrupted attempts: [What happened, when, and what stopped it] PAST ATTEMPTS AND SELF-HARM Past attempts: [Dates, methods, medical severity, intent, how the patient was found] Most recent attempt: [Circumstances, and how the patient feels about surviving] Self-harm without intent to die: [Type, frequency, most recent episode] RISK FACTORS, WARNING SIGNS, AND STRESSORS Clinical: [Depression, bipolar disorder, psychosis, substance use, recent discharge from hospital] Medical: [Chronic pain, serious or new illness, disability] Personal and family: [Family history of suicide, trauma, isolation, impulsivity] Recent stressors: [Losses, relationship breakdown, legal or money problems, shame] Warning signs: [Hopelessness, agitation, insomnia, withdrawal, more drinking or drug use, talk of death] PROTECTIVE FACTORS Reasons for living and supports: [People, children, pets, faith, future plans] Coping and engagement: [Skills that have worked, willingness to accept help] ACCESS TO LETHAL MEANS Firearms: [Asked directly; number, storage, who holds the keys and ammunition] Medications: [What is at home and how much, including over-the-counter] Other means: [Linked to the plan: ligatures, heights, vehicles, chemicals] What was agreed: [Who will remove, lock up, or reduce each means, and by when] COLLATERAL Contacts: [Name and relationship; consent given, or the reason for contact without it] What they reported: [What confirms or differs from the patient's account] MENTAL STATUS POINTS THAT BEAR ON RISK Mood and affect: [Mood in the patient's words; affect observed] Agitation and anxiety: [Restlessness, panic, sleep] Thought content: [Hopelessness, guilt, command hallucinations, delusions about death] Intoxication and cognition: [Whether the patient can be fully assessed now] Engagement: [Openness, and how consistent the account is] RISK FORMULATION Baseline risk: [Long-standing factors that set this patient's risk apart from the general population] Current risk: [Risk now compared with the patient's own baseline, and why] Modifiable factors: [What treatment, support, or means safety could change] Foreseeable changes: [Events that could raise risk soon: discharge, a court date, an anniversary, relapse] Overall judgment: [Level of concern, the main reasons, and the needs this plan meets] PLAN Level of care: [Outpatient, crisis team, intensive outpatient, voluntary or involuntary admission, and why] Safety plan: [Written with the patient and a copy given, or why not yet] Lethal means counseling: [What was discussed, with whom, and what was agreed] Treatment: [Medication changes, therapy, substance use care, referrals] Who was told: [Who, what was shared, and with what consent or under which exception] Follow-up: [Date, time, and clinician; who acts if the patient misses it] Crisis contacts given: [988 by call or text, local crisis line, 911, nearest emergency department] Consultation: [Supervisor, psychiatrist, or team consulted, and their advice] Signed: [Clinician name, credentials, date and time]
Use it for
Each one follows the template. Use them to judge how much detail every part needs.
Primary care, diabetes follow-up, in person
58-year-old man seen for a diabetes follow-up. PHQ-9 in the waiting room 16, with item 9 scored 1. Assessed at the same visit. Laid off from his job as a warehouse supervisor 5 weeks ago, after 22 years. Sources: the patient, his wife for the last part of the visit with his consent, and the chart. “Some nights I think it’d be easier not to wake up.”
Wishes he wouldn’t wake up, a few nights a week for about 3 weeks, usually when lying awake after midnight. Lasts a few minutes; he can set it aside by getting up or thinking of his family. No active thoughts of killing himself, now or ever. “I’d never do anything. My first grandkid is due in March.”
No plan, intent, or preparation. No research into methods, notes, goodbyes, or changes to his will or life insurance. No attempts that were started and stopped.
No past attempts or self-harm. No past psychiatric treatment.
Depressive symptoms for 5 weeks: early waking, low energy, poor appetite, stopped seeing friends. Severance ends in 7 weeks; worried about the mortgage. Drinking 3 or 4 beers most nights since the layoff, up from weekends only; AUDIT-C 5. Chronic low back pain. Brother treated for depression. Warning signs: insomnia and withdrawal; no agitation. Protective: married 31 years, close to his son and daughter, and his first grandchild is due in March. Names his family as the reason he wouldn’t act. Open about his thoughts, and wants help with his mood.
Asked directly about firearms: two hunting rifles in a locked cabinet in the basement, ammunition in the same cabinet; he holds the key. Agreed that his son will store both rifles and the ammunition at his house from tonight until we review it together; his wife will call the clinic once they are gone. Takes amitriptyline 25 mg at night for back pain, with about 80 tablets at home. Tricyclics are dangerous in overdose, so it is stopped today and the tablets go back to the pharmacy.
His wife has noticed poor sleep, more drinking, and that he has stopped seeing friends. He hasn’t talked about death or said goodbyes. She supports moving the rifles. Mental status: tired, casually dressed, good eye contact. Speech slow and quiet. Mood “flat”; affect restricted, brightens talking about the baby. Hopeless about finding work at his age, not about the future in general. No psychotic symptoms. Sober, alert, and oriented. Open, and his account matches his wife’s.
Baseline risk above the general population: a middle-aged man with chronic pain. Current risk raised above his own baseline by a new depressive episode, the job loss, heavier drinking, and rifles at home. Against that: no active thoughts, plan, intent, preparation, or past attempts, and strong reasons for living that he names himself. Modifiable: depression, drinking, money worry, and access to the rifles and amitriptyline. Risk would rise with active thoughts, heavier drinking, the end of his severance, or conflict at home. Overall: raised, with no current intent. He needs treatment for depression and drinking, means safety, and close follow-up, all of which can happen as an outpatient.
Outpatient care. Safety plan written with him and his wife: his warning signs, what helps, who to call, and the rifles out of the house; copy given, and a photo on his phone. Started sertraline 50 mg daily; discussed side effects, 4 to 6 weeks to full effect, and to call at once if suicidal thoughts get stronger. Advised cutting back on alcohol. Referral to the practice’s behavioral health clinician, first visit in 4 days. Told: his wife, with his consent. Discussed with the practice’s consulting psychiatrist by phone, who agreed with the plan. Crisis contacts: 988 by call or text, 911, or the nearest emergency department. Nurse phone check in 2 days; review with me in 1 week. If he misses either, the nurse calls him that day.
Emergency department, psychiatric assessment after medical clearance
27-year-old woman brought in by ambulance after taking about 48 tablets of acetaminophen 500 mg with half a bottle of wine. Treated with acetylcysteine; liver tests and INR normal at the end of treatment; medically cleared by the emergency physician. C-SSRS screener at triage: positive for active ideation with intent and a plan, and for suicidal behavior in the past 3 months. Assessed the morning after treatment ended, sober. Sources: the patient, her roommate’s account to the paramedics, her sister by phone with consent, and the hospital record. “I’m angry it didn’t work.”
Active thoughts of killing herself every day for about 3 weeks, since her partner of 4 years ended the relationship and she moved out. Present most of the day, hard to push away, worse at night and when drinking. Still present this morning; surviving has not changed them. Reason for dying: “I’m a burden, and it won’t get better.” Reason for living: her sister, though “she’ll get over it.”
Planned for about a week. Bought acetaminophen at three pharmacies over 5 days, read online about doses, and chose a weekend when her roommate was away. Wrote a note to her sister, and left her cat with a friend “for a few days.” Expected to die and told no one. Her roommate came home a day early and found her. Intent today: says she will try again once home, by a method she won’t name.
One overdose at 19, about 20 ibuprofen tablets after a breakup; she told her mother within an hour and was seen in emergency, not admitted. Cut her forearms between 15 and 17; none since. This attempt was more planned and more lethal than the last, with steps taken to avoid being found.
Recurrent depression, diagnosed at 22. Stopped sertraline 2 months ago without telling her doctor; no therapy since moving cities last year. Drinking a bottle of wine most nights for 3 weeks. Maternal uncle died by suicide. Stressors: the breakup, a move into a shared apartment, and about $9,000 of debt. Warning signs before the attempt: hopelessness, 3 or 4 hours of sleep a night, stopped answering friends. Protective: close to her younger sister, though she discounts the effect her death would have; her cat; still working as a graphic designer; agreed to talk today and to her sister being called. Right now, none of these is holding back her intent.
Asked directly: no firearms at the apartment or at her sister’s. Her roommate reports more acetaminophen and her old sertraline in the bathroom. Her sister has agreed to clear all medications from the apartment before any pass or discharge. The patient would not discuss means safety today; to revisit with the inpatient team.
Sister, by phone with consent: withdrawn for weeks, and said last week, “you’d all be fine without me.” Confirms the uncle’s death and the earlier overdose. The patient declined contact with her mother; respected. Mental status: hair unwashed, little eye contact, slowed. Speech quiet, short answers. Mood “nothing”; affect flat. Thought content: hopeless, sees herself as a burden, ongoing intent to die; no delusions or hallucinations. Not intoxicated, no signs of alcohol withdrawal, alert, and oriented. Guarded at first, then open; her account matches her sister’s.
Baseline risk well above the general population: a past attempt, past self-harm, recurrent depression, and a family history of suicide. Current risk far above her own baseline: a planned, high-lethality overdose with steps to avoid rescue, regret at surviving, ongoing intent, hopelessness, untreated depression, heavy drinking, and a recent loss. Her sister matters to her, but that has not held back her intent. Modifiable: depression, drinking, isolation, and access to medications. Risk would rise further if she went home alone or had contact with her ex-partner. Overall: high and current risk of a further attempt that can’t be managed safely in the community. She needs admission for safety and treatment.
Admission to the inpatient psychiatric unit; after discussion, she accepted a voluntary admission. Constant observation until reviewed by the inpatient team; belongings searched with her knowledge. Safety plan started, to be finished with the inpatient team before any pass. Means: her sister clears all medications from the apartment before any pass or discharge. Antidepressant restart and alcohol withdrawal monitoring to the inpatient team. Told: her sister, with consent; her roommate only that she is safe in hospital, with consent; her family physician through the discharge summary. Discussed with the on-call psychiatrist, who agreed. Outpatient follow-up to be booked within 7 days of discharge.
Why you are assessing today, and what the screen showed.
Avoid: Recording the screen result as the assessment. A positive item 9 tells you to ask more; it doesn’t tell you the risk.
What the thoughts are like: how often, how strong, and how long they last.
Avoid: “Positive SI.” Describe the thoughts, so the next clinician can see a change.
How far the thoughts have moved toward action: the details that weigh most.
Avoid: Asking only about a plan. A patient can say there is no plan and still have bought the means or written a note.
One of the strongest risk factors. Record enough detail to compare with today.
Avoid: “Hx of OD.” The intent and lethality of past attempts tell you more than the count.
Long-standing factors, recent changes, and what holds the patient back.
Avoid: A checklist with no weight. Say which factors matter most for this patient now, and whether the protective factors are actually holding.
What the patient could use, and what was agreed to make it safer. Reducing access to lethal means is one of the best-supported ways to prevent suicide.
Avoid: “Means discussed.” Write what is at home, what will change, who will do it, and how you will know it’s done.
What others have seen, and what you observe now.
Avoid: Finishing while the patient is intoxicated. Keep them safe; reassess once sober.
Your judgment, with the reasons behind it. It explains the risk, what drives it, and what the patient needs; it doesn’t predict whether they will die by suicide.
Avoid: A bare level with no reasons. Labels like “low risk” predict poorly; your reasoning and plan are what the next clinician needs.
What happens now, matched to the formulation.
Avoid: “Follow up as needed.” Book the next contact before the patient leaves, and say who reaches out if they don’t come.
When the patient denies intent but a note was found, means were bought, or family report goodbyes, write down both accounts and how you weighed them.
No scale or score predicts suicide well enough to decide who gets care. Use tools to structure the interview; base the plan on your formulation and the patient’s needs.
Ask every patient directly, in every setting. If there is a firearm, record where it is kept and what was agreed, such as storing it away from the home while risk is raised.
A promise to stay safe has no evidence behind it and can make patients less open. Write a safety plan with them instead, and record it.
Vero Scribe writes the suicide risk assessment in your template from the conversation, with the patient’s consent, or from your dictation. You review and edit every section, including the formulation, then copy it into your record or export it to Word or PDF. Vero works in 60+ languages.
Start with why you are assessing and the screen result. Ask about ideation, plan, intent, preparation, and past attempts; name the risk and protective factors; ask about lethal means; and talk to family or others when you can. Then write your formulation with its reasons, and a plan that matches it. The template follows that order.
Screening is a short, standard set of questions, such as the ASQ, the C-SSRS screener, or item 9 of the PHQ-9, that flags who needs a closer look. The assessment is the clinician’s interview and judgment after a positive screen or a disclosure, and it ends in a formulation and a plan.
If your organization asks for a level, give one, but never on its own. Add the reasons behind it, what would change it, and the needs the plan addresses. Current guidance warns against using a level or a score to predict suicide or to decide who gets care.
The risk assessment is your clinical record: what you found, how you weighed it, and what you decided. The safety plan is the patient’s own document, written with them, for what to do when a crisis builds. A safety plan often follows the assessment, and the assessment records that it was done.
Whenever risk may have changed: at follow-up after a positive screen, after a new stressor or an attempt, when observation levels change, and before a pass or discharge. Write a new assessment each time instead of copying the last one forward.
Yes. Copy it, or download it as a Word or text file. No account needed.
Capacity for one decision at one time: the information given, the four abilities in the patient’s words, the finding, and who decides next.
Falls history, gait and balance tests, orthostatic BP, medication review, and a plan matched to the risk.
The full pre-op assessment before noncardiac surgery: history, capacity, RCRI, airway, medication plan, and a clear recommendation.
System-by-system exam with normal findings written out, space for abnormal findings, and sensitive exams when indicated.
After a job offer: the job’s demands, relevant history, immunizations, vision and hearing, a job-focused exam and tests, and a fit outcome without the diagnosis.
Emergency and outpatient assessments, drafted for your review.
Intake, progress, and risk notes, drafted from the session.
A structured checklist for each domain, with documentation examples.
Vero writes your notes and letters in the templates you choose, so you review instead of type.
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