(To be filled out by offender and safe guard together)

1. List at least 4 seemingly unimportant events (choices) that lead up to your actual offense.

a. Offender

b. Safe guard

2. Identify each dangerous situation based on the offender's particular deviant behavior patterns.

a. Offender

b. Safe guard

3.For each lapsed behavior list alternative choices/actions that could have replaced each event.

a. Offender

b. Safe guard

4.Using the offense cycle of the abuser, write an alternative cycle for each "lapse" within the cycle where the offender could have used avoidance or escape to change the chain of events.

a. Offender

b. Safe guard

Signature Offender: __________________________ Date: _________________

Signature Safe guard:_________________________ Date: _________________