Taking care of yourself better is not only important to you but also to everyone around you. When you aren’t practicing self-care every day, you probably not as healthy as you could be. This means you aren’t at your best and you aren’t able help others much.

To help you optimize and/or increase your self-care fill in each section of this self-care assessment sheet to give you an idea of what you need to work on, to feel better yourself and to be there for others.

For each of the following, rate how well you rate on each item. Use the number-system with 1 being poor and 5 being the best. Write your score in the line by the item. Then total up the numbers in each section and put it on the total score line by the section title.

Physical Self-Care – Total Score ________

___ I exercise 3-5 times a week.

___ I eat 3 healthy meals daily.

___ I eat healthy snacks.

___ I follow a healthy sleep routine.

___ I avoid eating at fast food restaurants.

___ I visit my family doctor regularly.

___ I visit my dentist regularly.

___ I drink water for better hydration.

___ I incorporate weights in my exercises.

___ I take medications as prescribed.

I want/need to build/enhance these qualities:

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Mental Self-Care – Total Score ________

___ I write in a journal regularly.

___ I keep up with current news & events.

___ I play cognitive games that challenge me.

___ I engage in at least one hobby a week.

___ I listen to relaxing music.

___ I call or write to keep in touch with people I care for.

___ I volunteer regularly.

___ I visit places that I enjoy at least twice a week.

___ I learn to do something new each week.

___ I practice self-compassion and acceptance.

I want/need to build/enhance these qualities:

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Emotional Self-Care – Total Score ________

___ I journal about things that bother/worry me.

___ I talk about troubling thoughts with a trusted friend.

___ I make it a point to be kind to others.

___ I don’t take hurtful things to heart.

___ I listen to upbeat or sad music as needed.

___ I watch inspiring or funny movies/shows to cheer up.

___ I don’t allow my anger or frustration to affect others.

___ I read the news or books to keep my thoughts in perspective.

___ I tell people what I really think, in appropriate way.

___ I effectively limit the time I spend with toxic people.

I want/need to build/enhance these qualities:

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Social Self-Care – Total Score ________

___  I schedule one-on-one time each person in my immediate family.

___ I participate in community events regularly.

___  I am part of several community groups.

___  I encourage my family and friends to try new things.

___  I check on my friends/family regularly.

___  I tell my friends and family why I appreciate them.

___  I effectively balance the time I need for myself and with others.

___  I ask for help when needed.

___  I offer help when I see another’s unfulfilled need.

___  I make new people feel welcome and valued.

I want/need to build/enhance these qualities:

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Business Self-Care

___  I arrive/begin work on time.

___  I work with a peer-support group.

___  I work with others a team-player.

___  I compliment others on their work.

___  I follow the rules/instructions set for my job.

___  I read industry-related information regularly.

___  I regularly build and enhance my job skills.

___  I keep my desk/office clean and organized.

___  I take time off only when needed.

___  I take 15-minute breaks as needed.

I want/need to build/enhance these qualities:

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