Name: Hour:

Health Self-Inventory

Directions: Read each item and write true for each one that accurately describes your behavior.
Total the number of true responses, then move on to the next section.

PHYSICAL HEALTH:

1. I get at least 8 hours of sleep each night.
2. I brush my teeth and use dental floss after each meal.
3. I do not use tobacco, and I avoid secondhand smoke.
4. I keep within 5 pounds of my ideal weight or weigh within the normal weight range for
people of my age, height, frame, and sex.
5. I use a seat belt and refuse to ride in cars with drivers who have been using alcohol or
other drugs.
6. I do at least 20 minutes of aerobic exercise at least 3 times a week.
7. I eat a healthy breakfast every day.
8. I do not use alcohol or illegal drugs or misuse standard medicines.
9. I relax 10 minutes a day.
10. I eat a balanced diet.
11. I use sunscreen when necessary.
12. I get dental and medical checkups once each year.


MENTAL HEALTH
13. I generally like and accept who I am.
14. I ask for help when I need it.
15. I can express my emotions in healthy ways.
16. I can enjoy being alone.
17. I can name 3 positive qualities about myself.
18. I feel okay about crying.
19. I can accept constructive criticism.
20. I can be satisfied when I have done my best.
21. I express my thoughts and feelings to others.
22. I have at least 1 hobby that I enjoy.
23. I deal with stresses as they happen and dont let them build up.
24. Sometimes I feel afraid, angry, sad, or jealous, but I am not overwhelmed by these
emotions.

SOCIAL HEALTH
25. I am generally satisfied with my relationships with others.
26. I meet people easily and I am usually comfortable entering into conversations.
27. I can be myself when Im with people I know well.
28. I can still participate in an activity even though I dont get my way.
29. I have at least 1 or 2 close friends.
30. I do not abuse others or allow them to abuse me.
31. When working in a group, I can accept other peoples ideas and suggestions.
32. I can say NO to my friends and peers, especially when they ask me to do things that might
damage my or someone elses health, safety, or self-esteem.
33. I can accept the differences in people.
34. If I have a problem with someone, I try to work it out.
35. I avoid gossiping about people.
36. I make important life decisions carefully.

YOUR SCORE

30-36 VERY GOOD
21-29 GOOD
12-20 FAIR
12-below- POOR


WHAT ARE YOUR GOALS?

Look over your score and choose an area in which you can improve upon. Begin the goal setting
process by completing the following prompts:

1. The behavior I would like to change or improve is:



2. If this behavior were completely changed, the benefits I would receive are:



3. The steps involved in making this change are:




4. The people I will ask for support and assistance are:



5. My reward for achieving this goal will be: