Negotiation Checklist
Today, I want to be a...
Name:
Top Bottom Switch
Playing With:
For Each Activity, Rate Interest • Complete it, then discuss. Ask, “What do you mean
by…?” (my “heavy impact” may not be yours).
• Negotiate before play, especially with new partners
5 = Yes, Please!
4 = OK or new activities.
3 = Curious • During a scene, it’s safer to remove activities than
2 = Maybe add ones you didn’t agree to.
1 = Soft Limit • Don’t up-negotiate mid-scene.
0 = Hard Limit • Consent is informed, enthusiastic, and reversible—
you can pause or stop at any time.
• Afterward, feelings may change; regret is real and
How to Use This Checklist deserves care.
• If you realize you didn’t or couldn’t consent, that
• This sheet begins negotiation—honest answers help isn’t “regret”—it’s a violation.
you find overlap. • Debrief together and plan aftercare/check-ins.
• There are no right or wrong answers, and you won’t
get everything you want.
Clothing Rating Notes
Safewords Rating Notes Being Naked
"_____________" Chastity Belt
Non-Verbal (discuss) Corset
Plain Language High Heels
Red /Yellow/Green Latex Clothing
"Safeword" Stripping
Other Underwear
Other
I Want to Feel... Rating Notes Power Exchange
Rating Notes
(D / S)
Beautiful
Choking
Catharsis
Commands /
Controlled Instructions
Degraded Humiliation Play
Dominant Kneeling
Energetic Leash
Erotic Orgasm Control /
Helpless Denial
Masochistic Pet Play
Overwhelmed Verbal Degradation
Peaceful Wearing Collar
Platonic Other
Playful
Sadistic
Impact Play Rating Notes
Serious
Submissive Biting
Other Canes
Clamps
Clothespins
Bondage Rating Notes Face Slapping
Bench Floggers
Blindfolds Hair Pulling
Box Tie / TK Heavy
Cages Intro
Cross Light
Decorative Paddles
Floor Bondage Pinching
Gags Punching
Handcuffs Rough Play
Hoods Spanking
Leather Stingy
Mental Thuddy
Metal Cuffs Whips
Restraints Other
Restrictive
Rope
Marks Rating Notes
Suspension
Table None
Other For Today
For the Week
Longer (discuss)
Other
Touching, Intimacy,
Rating Notes
Sex
Role Play Rating Notes 69ing
Boss / Employee
Anal Rimming
Burglar /Victim Condoms / Dent Dams
Dirty Talk Consensual Non-
Doctor / Patient Monogamy
Domestic Tasks Cuddling
Edging
Forced Exercise
Exhibitionism
Human Furniture
Face Sitting
Interrogation
Kidnapper / Captive Fluid Exchange
Law Enforcer / Convict Groping
Hand Job (Giving /
Little Receiving)
Non-con Hands on Genitals
Reading Erotica Kissing
Royalty / Servant Lap Dancing
Sexting Massage
Teacher/Student Mutual Masturbation
Watching Porn Oral Sex (Giving /
Wealthy / Commoner Receiving)
Orgasms
Other
Scissoring / Grinding
Squirting
Sensation Play Rating Notes Threesome
Biting Toys & Accessories
Edge Play Other
Electricity Play
Fire Play
Penetration Rating Notes
Food Play
Anal
Knives
Anal Fisting
Licking
Fingers
Nipple Play
G-Spot Play
Oils & Lotions
Oral
Pinching
Pegging
Playing with Hair
Penis
Pressure Points
Prostate Play
Scratching
Sex (Anal)
Sensory Deprivation
Sex (Intercourse)
Shaving
Sex Toys
Temperature Play
Strap On
Tickling
Vaginal
Wartenberg Wheel
Vaginal Fisting
Wax Play
Other
Other
Aftercare Rating Notes I Do Not Want To Be Touched Here:
~ ___ - ___ Mins
Blanket
Check In Tomorrow
Comfort Item
Conversation
Cuddling
Electrolytes
Let Me Be
Massage
Salt
Service
Snacks
Snuggly Clothes
Socialize
Sugar
Water
Other
You Should Know About My: Any Other Ideas, Limits, Comments, Details:
Partners: __________________________________________ __________________________________________________
_____________________________________________________ __________________________________________________
Triggers: _________________________________________ __________________________________________________
_____________________________________________________ __________________________________________________
Medical Conditions & Meds: ___________________ __________________________________________________
_____________________________________________________ __________________________________________________
Injuries: ___________________________________________ __________________________________________________
_____________________________________________________ __________________________________________________
STI Status: ________________________________________ __________________________________________________
_____________________________________________________ __________________________________________________
Allergies: _________________________________________ __________________________________________________
_____________________________________________________ __________________________________________________
Safe Call (Trusted Friend or Contact): ________ __________________________________________________
_____________________________________________________ __________________________________________________
