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Physical Self-Care

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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

  1. List the self-care habits you are using now to manage stress and stay healthy.
  1. List the self-care habits you would like to use but are not currently practicing.
  1. Identify the obstacles keeping you from practicing these habits.
  1. What solutions can you come up with to address the obstacles you identified?
  1. 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…

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