Description
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Self-Care Assessment Worksheet
This assessment tool provides an overview of effective strategies to maintain self-care. After completing the full assessment, you can move on to developing a full self-care plan. Using the scale below, rate the following areas in terms of frequency:
5 = Frequently 4 = Occasionally 3 = Rarely 2 = Never 1 = It never occurred to me
Physical Self-Care
___ Eat regular healthy meals
___ Exercise
___Get regular medical care
___ Take breaks
___ Dance, swim, walk, run, play sports, sing, or do some other physical activity that is fun
___ Get enough sleep
___ Wear clothes you like
___Take day trips or mini-vacations
___Take time away from gadgets
___ Total
Psychological Self-Care
___Write in a journal
___ Read for pleasure
___Do something at which you are not an expert or in charge
___ Create a comfortable space where you live
___Make time to complete tasks
___Be aware of your self-talk
___ Try new things
___ Allow others to help you
___Say no to things you don’t want to do
___ Total
Emotional Self-Care
___ Spend time with people whose company you enjoy
___ Stay in contact with important people in your life
___ Give yourself affirmations/praise
___ Accept yourself as you are now
___ Re-read favorite books, re-view favorite movies/tv shows
___ Identify comforting activities, objects, people, relationships, and places and seek them out
___Allow yourself to cry
___ Find things to make you laugh
___ Play with children or animals
___ Total
Spiritual Self-Care
___ Spend time outside
___Find a spiritual connection or community
___ Be open to inspiration
___ Appreciate the little things
___ Identify what is meaningful to you and notice its place in your life
___Meditate or pray
___Volunteer
___ Practice gratitude
___ Be open to not knowing the answers
___ Total
Self-Care Planning Worksheet
- List the self-care habits you are using now to manage stress and stay healthy.
- List the self-care habits you would like to use but are not currently practicing.
- Identify the obstacles keeping you from practicing these habits.
- What solutions can you come up with to address the obstacles you identified?
- Reread the self-care habits you wrote down for item 2. Select one of the habits you would like to begin practicing and complete the sentences below.
a. Today, I commit to…
b. I want to do this because…
c. I will accomplish this by…
