Trying to record self-harm urges, incidents, thoughts and feelings soon after they happen can feel hard without a clear structure. A printable self-harm diary form gives space to note the day, time, situation, thoughts, emotions and actions, helping someone and their support worker spot patterns over time.
This self-harm diary form is a printable PDF designed to help someone record what was happening before, during or after an urge or incident. The simple table gives space to note the day, time, situation, thoughts, feelings and actions, so patterns around self-harm, self-injury urges, emotional distress and coping behaviours can be explored more clearly.
It can be used by teenagers, young people or adults who are already receiving support, as well as by practitioners, counsellors, support workers, social workers, CAMHS staff or trusted carers. The form may be helpful before an appointment, during a support session, or as part of a wider safety plan or coping strategy discussion.
Because the layout is brief, it can be filled in without needing long written reflections. Users might print several copies, keep them in a folder, or bring completed sheets to a meeting to talk through triggers, difficult emotions, unhelpful thoughts, what helped, and what could be tried next. It is intended as a prompt for reflection and conversation, not as a replacement for professional help.
Download and print the free self-harm diary worksheet to support structured note taking at home, in school, in college, or within mental health and wellbeing services. This resource was created by MindWell Leeds.
