The cues that ( husband ) _______________ is getting angry are:

_________________      ______________________

_________________      ______________________

The cues that ( wife )___________________ is getting angry are:

_________________        _____________________

_________________         ____________________

The triggers ( red flags ) that we need to avoid are:

_________________      _____________________
_________________     _____________________

The neutral, non-blaming TIME-OUT sign that we will use will be:

__________________________________________

When either give the above signal ( i.e., limit this time to being alone in bedroom, bathroom, out on porch, very short walk )

husband will go: ____________________________

wife will go: _______________________________

When my partner gives the TIME-OUT signal I  will abide by this contract.

The TIME-OUT will last for __________ minutes. ( 15 to 30 minutes only ).

During the TIME-OUT we  will observe the following rules:

- Don't call a friend or parent
-Don't drink alcohol or caffeine
-Don't drive. 
-Use the Time Out
-Process what's going on inside of me.

At the end of the TIME-OUT period we will:

-Review the Time Out - using "I" statements
-Not leave the conflict unresolved
-Talk about how I perceived the situation
-How I felt about what happened and what was said
-What it is I need
-Not leaving the other to assume; allowing them to fail meeting silent expectations


Signed ____________________________________
Dated____________

Witness ( Friend ) ___________________________Dated____________