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Created on By wjdevelopmental

Good Self-Care Assessment

Rate each statement with one of the following: 1 – Rarely 2 – Sometimes 3 – Frequently

Good Self-Care Assessment Log-in Form

Review your responses and consider the following for each statement.
1 – Rarely Needs improvement - let’s talk about how to strengthen this area.
2 – Sometimes Good job! We can come up with ideas to help you be more consistent.
3 – Frequently Great job! Keep up the good work!

1 / 10

I get plenty of rest and sleep 7-8 hours daily

Review your responses and consider the following for each statement.
1 – Rarely Needs improvement - let’s talk about how to strengthen this area.
2 – Sometimes Good job! We can come up with ideas to help you be more consistent.
3 – Frequently Great job! Keep up the good work

2 / 10

I eat healthy foods and regular meals

Review your responses and consider the following for each statement.
1 – Rarely Needs improvement - let’s talk about how to strengthen this area.
2 – Sometimes Good job! We can come up with ideas to help you be more consistent.
3 – Frequently Great job! Keep up the good work!

3 / 10

 I maintain contact with people who support me emotionally

Scoring:
Review your responses and consider the following for each statement.
1 – Rarely Needs improvement - let’s talk about how to strengthen this area.
2 – Sometimes Good job! We can come up with ideas to help you be more consistent.
3 – Frequently Great job! Keep up the good work!

4 / 10

I exercise 30 minutes or more 3-5 times per week.

Review your responses and consider the following for each statement.
1 – Rarely Needs improvement - let’s talk about how to strengthen this area.
2 – Sometimes Good job! We can come up with ideas to help you be more consistent.
3 – Frequently Great job! Keep up the good work!

5 / 10

I take a break at work every 1 – 1.5 hours to stretch and move around.

Review your responses and consider the following for each statement.
1 – Rarely Needs improvement - let’s talk about how to strengthen this area.
2 – Sometimes Good job! We can come up with ideas to help you be more consistent.
3 – Frequently Great job! Keep up the good work!

6 / 10

I engage in spiritual activities regularly

Review your responses and consider the following for each statement.
1 – Rarely Needs improvement - let’s talk about how to strengthen this area.
2 – Sometimes Good job! We can come up with ideas to help you be more consistent.
3 – Frequently Great job! Keep up the good work!

7 / 10

I play! I do something fun at least once a week.

Review your responses and consider the following for each statement.
1 – Rarely Needs improvement - let’s talk about how to strengthen this area.
2 – Sometimes Good job! We can come up with ideas to help you be more consistent.
3 – Frequently Great job! Keep up the good work!

8 / 10

I nurture my relationships – call/write/email/visit/talk/date.

9 / 10

I get outside daily – the fresh air and lush greenery are good for me!

Review your responses and consider the following for each statement.
1 – Rarely Needs improvement - let’s talk about how to strengthen this area.
2 – Sometimes Good job! We can come up with ideas to help you be more consistent.
3 – Frequently Great job! Keep up the good work!

10 / 10

I use my down time to rejuvenate – do something I enjoy.

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