Self-Care Assessment Worksheet

This assessment tool provides an overview of effective strategies to maintain self-care.

After completing the full assessment, choose one item from each area that you will
actively work to improve.
Using the scale below, rate the following areas in terms of frequency (how often you
complete the activity)
5 = Frequently
4 = Occasionally
3 = Rarely
2 = Never
1 = It never occurred to me

Physical Self-Care
__5_ Eat regularly (e.g. breakfast, lunch and dinner)
_4__ Eat healthy
__5_ Exercise
__3_ Do medical care for prevention (check-ups, vitamins, blood tests)
__5_ Get medical care when needed
__5_ Dance, swim, walk, run, play sports, sing, or do some other physical activity that is
fun
_4__ Get enough sleep (at least 8 hours)
_4__ Wear clothes you like
__5_ Do activities with your family
__3_ Make time away from telephones, social media, games
__3_ Other:

Psychological Self-Care
__5_ Make time for self-reflection
_5__ Write in a journal
_4__ Read a book of interest to you
__5_ Learn a new skill or hobby (baking, cooking, gardening, etc.)
__3_ Decrease stress in your life
_3__ Let others know different aspects of you
___4 Notice your inner experience—listen to your thoughts, judgments, beliefs,
attitudes, and feelings
_4__ Other:

Emotional Self-Care
__5_ Spend time with others whose company you enjoy
_5__ Stay in contact with important people in your life
_5__ Love yourself as you are
_3__ Re-read favorite books, re-view favorite movies
__5_ Identify comforting activities, objects, people, relationships, places and seek them
out
_5__ Allow yourself to cry
__5_ Find and do things that make you laugh
_5__ Play with siblings
_5__ Other:

Spiritual Self-Care
_5__ Make time for reflection/devotion
_5__ Spend time with nature
_5__ Find a spiritual connection or community
_5__ be open to inspiration
_5__ Cherish your optimism and hope
_5__ Be aware of nonmaterial aspects of life
_4__ Try at times not to be in charge or the expert
__5_ Be open to not knowing
_5__ Identify what in meaningful to you and notice its place in your life
_5__ Meditate
_5__ Pray
__5_ Sing
_4__ Spend time with children
__4_ Have experiences of awe
__3_ Contribute to causes in which you believe
_5__ Read inspirational literature (talks, music, etc.)
__5_ other: