🖤 BDSM Scene Negotiation & Consent Worksheet
Combining the values of SSC & RACK: RISK risk aware, informed and consensual, safe and sane kink play checklist!
🧠 1. Personal Information (Optional, But Helpful)
| Partner | Scene Name | Role(s) | Experience Level |
|---|---|---|---|
| You | ☐ New ☐ Int ☐ Exp | ||
| Partner | ☐ New ☐ Int ☐ Exp |
💬 2. Pre-Scene Communication
What are your goals for this scene?
(e.g., pleasure, catharsis, power exchange, testing limits)
Emotional state going in?
(check in with each other)
Is aftercare needed?
☐ Yes ☐ No ☐ Maybe
Preferred aftercare: ________________________
🧷 3. Hard & Soft Limits
Hard Limits (Absolutely No)
Soft Limits (Maybe / With Caution)
Trigger warnings / trauma considerations?
🔐 4. Consent and Safewords
- Safeword for full stop: _________
- Safeword for slow down/check in: __
- Non-verbal safe gesture (if gagged or muted): __
Consent level: ☐ Scene-specific only
☐ Part of a 24/7 or ongoing dynamic
☐ Ongoing, renegotiable
Consent is:
☐ Informed (understands all risks)
☐ Freely given (no coercion)
☐ Ongoing (can be withdrawn anytime)
⚙️ 5. Activities Checklist
🟩 = Yes, enthusiastically
🟨 = Maybe/Curious
🟥 = No/Hard limit
| Activity Type | You | Partner | Notes or Boundaries |
|---|---|---|---|
| Bondage (Rope, Tape) | |||
| Impact Play (Spank, Flog) | |||
| Sensory Deprivation | |||
| Roleplay / Petplay | |||
| Power Exchange (D/s) | |||
| Edging / Denial | |||
| Wax Play | |||
| Medical/Needle Play | |||
| Breath Play | |||
| Humiliation/Degradation | |||
| Orgasm Control | |||
| Exhibition/Voyeurism | |||
| Verbal Control / CNC Scenes | |||
| Other: __ |
🧠 6. Risk-Awareness & Check-In
Are you aware of the risks involved in these activities?
☐ Yes ☐ No ☐ Somewhat
Have you researched or discussed medical/emotional implications of play?
☐ Yes ☐ No
Are you both physically/emotionally fit for play today?
☐ Yes ☐ No ☐ Will reassess before beginning
💞 7. Aftercare Plan
| Partner | Type of Aftercare (check all that apply) |
|---|---|
| You | ☐ Cuddles ☐ Water ☐ Space ☐ Debrief ☐ Alone time ☐ Check-ins next day |
| Partner | ☐ Cuddles ☐ Water ☐ Space ☐ Debrief ☐ Alone time ☐ Check-ins next day |
Any aftercare items needed on hand (blankets, snacks, comfort objects, etc)?
📋 8. Scene Debrief (Post-Play, Optional)
- What went well? __________________________
- What didn’t feel good or needs adjusting? __
- Were boundaries respected? ________________
- How do we feel emotionally right now? _____
✍️ 9. Consent Sign-Off
☐ We agree that this scene will proceed based on our shared understanding of limits, boundaries, and risks.
☐ We will stop the scene immediately if a safeword or gesture is used.
☐ We acknowledge consent can be withdrawn at any time.
| Your Signature (optional) | _______________ | | Partner Signature | _______________ | | Date | _______________ |
