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WorksheetsSelf-care evaluation
Total questions: 27
Worksheet time: 5mins
Rate how well or how frequently you believe that you engage in each activity.
(The list is not exhaustive - some activities may not appeal to you at all, or you may feel that others are missing. If you think of ideas that you’d like to add to the list, hang on to those ideas - we'll add them at the end!)
Enjoy hobbies like painting, snowboarding/skiing, playing guitar, baking, or gardening
1 I rarely do this/I don’t do this well/I don’t care to do this
2 I sometimes do this/I’m average at doing this
3 I do this often/I do this very well
* I’d like to do this more often/I’d like to become better at this
Unplug from technology
1 I rarely do this/I don’t do this well/I don’t care to do this
2 I sometimes do this/I’m average at doing this
3 I do this often/I do this very well
* I’d like to do this more often/I’d like to become better at this
Journal or talk with others about emotions/feelings
1 I rarely do this/I don’t do this well/I don’t care to do this
2 I sometimes do this/I’m average at doing this
3 I do this often/I do this very well
* I’d like to do this more often/I’d like to become better at this
Express gratitude (written or verbal)
1 I rarely do this/I don’t do this well/I don’t care to do this
2 I sometimes do this/I’m average at doing this
3 I do this often/I do this very well
* I’d like to do this more often/I’d like to become better at this
Rest on days off
1 I rarely do this/I don’t do this well/I don’t care to do this
2 I sometimes do this/I’m average at doing this
3 I do this often/I do this very well
* I’d like to do this more often/I’d like to become better at this
Maintain regular appointments (dentist, doctor, chiropractor, etc)
1 I rarely do this/I don’t do this well/I don’t care to do this
2 I sometimes do this/I’m average at doing this
3 I do this often/I do this very well
* I’d like to do this more often/I’d like to become better at this
Get 8 hours of sleep per night
1 I rarely do this/I don’t do this well/I don’t care to do this
2 I sometimes do this/I’m average at doing this
3 I do this often/I do this very well
* I’d like to do this more often/I’d like to become better at this
Drink plenty of water
1 I rarely do this/I don’t do this well/I don’t care to do this
2 I sometimes do this/I’m average at doing this
3 I do this often/I do this very well
* I’d like to do this more often/I’d like to become better at this
Engage in regular physical exercise
1 I rarely do this/I don’t do this well/I don’t care to do this
2 I sometimes do this/I’m average at doing this
3 I do this often/I do this very well
* I’d like to do this more often/I’d like to become better at this
Eat a healthy diet
1 I rarely do this/I don’t do this well/I don’t care to do this
2 I sometimes do this/I’m average at doing this
3 I do this often/I do this very well
* I’d like to do this more often/I’d like to become better at this
Speak regularly with close friends and family
1 I rarely do this/I don’t do this well/I don’t care to do this
2 I sometimes do this/I’m average at doing this
3 I do this often/I do this very well
* I’d like to do this more often/I’d like to become better at this
Ask others for help when you need it
1 I rarely do this/I don’t do this well/I don’t care to do this
2 I sometimes do this/I’m average at doing this
3 I do this often/I do this very well
* I’d like to do this more often/I’d like to become better at this
Stay in contact with distant connections through FaceTime, Skype, Zoom, etc.
1 I rarely do this/I don’t do this well/I don’t care to do this
2 I sometimes do this/I’m average at doing this
3 I do this often/I do this very well
* I’d like to do this more often/I’d like to become better at this
Spend quality time with family members (who live in your home)
1 I rarely do this/I don’t do this well/I don’t care to do this
2 I sometimes do this/I’m average at doing this
3 I do this often/I do this very well
* I’d like to do this more often/I’d like to become better at this
Do fun activities with others, even if they are through online platforms for now (book clubs, video games, etc.)
1 I rarely do this/I don’t do this well/I don’t care to do this
2 I sometimes do this/I’m average at doing this
3 I do this often/I do this very well
* I’d like to do this more often/I’d like to become better at this
Seek help from colleagues when needed
1 I rarely do this/I don’t do this well/I don’t care to do this
2 I sometimes do this/I’m average at doing this
3 I do this often/I do this very well
* I’d like to do this more often/I’d like to become better at this
Maintain a comfortable and pleasant work environment
1 I rarely do this/I don’t do this well/I don’t care to do this
2 I sometimes do this/I’m average at doing this
3 I do this often/I do this very well
* I’d like to do this more often/I’d like to become better at this
Set clear boundaries for yourself and communicating them to others when needed
1 I rarely do this/I don’t do this well/I don’t care to do this
2 I sometimes do this/I’m average at doing this
3 I do this often/I do this very well
* I’d like to do this more often/I’d like to become better at this
Say “no” when you need to
1 I rarely do this/I don’t do this well/I don’t care to do this
2 I sometimes do this/I’m average at doing this
3 I do this often/I do this very well
* I’d like to do this more often/I’d like to become better at this
Balance work and free time
1 I rarely do this/I don’t do this well/I don’t care to do this
2 I sometimes do this/I’m average at doing this
3 I do this often/I do this very well
* I’d like to do this more often/I’d like to become better at this
Take lunch breaks and short screen breaks throughout the day
1 I rarely do this/I don’t do this well/I don’t care to do this
2 I sometimes do this/I’m average at doing this
3 I do this often/I do this very well
* I’d like to do this more often/I’d like to become better at this
Take lunch breaks and short screen breaks throughout the day
1 I rarely do this/I don’t do this well/I don’t care to do this
2 I sometimes do this/I’m average at doing this
3 I do this often/I do this very well
* I’d like to do this more often/I’d like to become better at this
Enjoy time in nature
1 I rarely do this/I don’t do this well/I don’t care to do this
2 I sometimes do this/I’m average at doing this
3 I do this often/I do this very well
* I’d like to do this more often/I’d like to become better at this
Religious practice
1 I rarely do this/I don’t do this well/I don’t care to do this
2 I sometimes do this/I’m average at doing this
3 I do this often/I do this very well
* I’d like to do this more often/I’d like to become better at this
Mindfulness/Meditation/Yoga
1 I rarely do this/I don’t do this well/I don’t care to do this
2 I sometimes do this/I’m average at doing this
3 I do this often/I do this very well
* I’d like to do this more often/I’d like to become better at this
Appreciate beauty (e.g. music, art, literature)
1 I rarely do this/I don’t do this well/I don’t care to do this
2 I sometimes do this/I’m average at doing this
3 I do this often/I do this very well
* I’d like to do this more often/I’d like to become better at this
Allocate regular quiet time for reflection
1 I rarely do this/I don’t do this well/I don’t care to do this
2 I sometimes do this/I’m average at doing this
3 I do this often/I do this very well
* I’d like to do this more often/I’d like to become better at this
