To be filled out by the offender and safe guard

1. Identify the offenders major thinking errors.

a. Offender:

b. Safe guard:

2. Identify when the offender's thinking errors are likely to occur.

a. Offender:

b. Safe guard:

3. Identify how you would/will respond to the offender's thinking errors.

a. Offender:

b. Safe guard:

4. Identify 4 primary stressors that the offender reacts negatively to in his life and his patterns of response.

a. Offender:

b. Safe guard:

5. What needs to be put into place for healthy responses to occur and what would they be?

a. Offender:

b. Safe guard:

Signature of Offender:_________________________

Signature Safe guard:___________________________

Date: _________________