Self-Care Assessment Worksheet - www4

<strong>Self</strong>-<strong>Care</strong> Checklist<br />

This assessment tool provides an overview of effective strategies that you<br />

can do to maintain your resilience and promote personal sustainability. After<br />

completing the full assessment, choose one item from each area that you will<br />

actively work on to take good care of yourself.<br />

Using the scale below, rate the following areas in terms of frequency:<br />

5 = Frequently<br />

4 = Occasionally<br />

3 = Rarely<br />

2 = Never<br />

1 = It never occurred to me<br />

Physical <strong>Self</strong>-<strong>Care</strong><br />

___ Eat regularly (e.g. breakfast, lunch and dinner)<br />

___ Eat healthy<br />

___ Exercise<br />

___ Get regular medical care for prevention<br />

___ Get medical care when needed<br />

___ Take time off when needed<br />

___ Get massages<br />

___ Dance, swim, walk, run, play sports, sing, or do some other physical<br />

activity that is fun<br />

___ Take time to be sexual—with yourself, with a partner<br />

___ Get enough sleep<br />

___ Wear clothes you like<br />

___ Take vacations<br />

___ Take day trips or mini-vacations<br />

___ Make time away from telephones<br />

___ Other:<br />

Psychological <strong>Self</strong>-<strong>Care</strong><br />

___ Make time for self-reflection<br />

___ Have your own personal counselor or coach if you need one<br />

___ Write in a journal<br />

___ Read literature that is unrelated to work<br />

___ Do something at which you are not expert or in charge<br />

___ Decrease stress in your life

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___ Let others know different aspects of you<br />

___ Notice your inner experience—listen to your thoughts, judgments,<br />

beliefs, attitudes, and feelings<br />

___ Engage your intelligence in a new area, e.g. go to an art museum, history<br />

exhibit, sports event, auction, theater performance<br />

___ Practice receiving from others<br />

___ Be curious<br />

___ Say “no” to extra responsibilities sometimes<br />

___ Other:<br />

Emotional <strong>Self</strong>-<strong>Care</strong><br />

___ Spend time with others whose company you enjoy<br />

___ Stay in contact with important people in your life<br />

___ Give yourself affirmations, praise yourself<br />

___ Love yourself<br />

___ Re-read favorite books, re-view favorite movies<br />

___ Identify comforting activities, objects, people, relationships, places and<br />

seek them out<br />

___ Allow yourself to cry<br />

___ Find things that make you laugh<br />

___ Express your outrage in social action, letters and donations, marches,<br />

protests<br />

___ Play with children<br />

___ Other:<br />

Spiritual <strong>Self</strong>-<strong>Care</strong><br />

___ Make time for reflection<br />

___ Spend time with nature<br />

___ Find a spiritual connection or community<br />

___ Be open to inspiration<br />

___ Cherish your optimism and hope<br />

___ Be aware of nonmaterial aspects of life<br />

___ Try at times not to be in charge or the expert<br />

___ Be open to not knowing<br />

___ Identify what is meaningful to you and notice its place in your life<br />

___ Meditate<br />

___ Pray<br />

___ Sing

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___ Spend time with children<br />

___ Have experiences of awe<br />

___ Contribute to causes in which you believe<br />

___ Read inspirational literature (talks, music, etc.)<br />

___ Other:<br />

Workplace or Professional <strong>Self</strong>-<strong>Care</strong><br />

___ Take a break during the workday (e.g. lunch)<br />

___ Take time to chat with co-workers<br />

___ Make quiet time to complete tasks<br />

___ Identify projects or tasks that are exciting and rewarding<br />

___ Set limits with your clients and colleagues<br />

___ Balance your workload so that no one day or part of a day is “too much”<br />

___ Arrange your work space so it is comfortable and comforting<br />

___ Get regular supervision or consultation<br />

___ Negotiate for your needs<br />

___ Have a peer support group<br />

___ Develop or explore other areas of professional interest<br />

___ Other:<br />

Balance<br />

___ Strive for balance within your work-life and workday<br />

___ Strive for balance among work, family, relationships, play and rest<br />

Adapted from: Saakvitne, K.W. and Pearlman,L.A. (1996). Transforming the<br />

Pain: A Workbook on Vicarious Traumatization. New York: Norton.