Fillable Self-Care Assessment Worksheet

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Self-Care Assessment Worksheet

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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, choose one item from each area that you will actively work to improve.
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 regularly (e.g. breakfast, lunch, and dinner)
____ Eat healthy
____ Exercise
____ Get regular medical care for prevention
____ Take time off when needed
____ Get massages
____ Dance, swim, walk, run, play sports, sing, or do some other physical activity that is fun
____ Get enough sleep
____ Wear clothes you like
____ Take vacations
____ Take day trips or mini-vacations
____ Make time away from telephones
____ Other:
Psychological Self-Care
____ Make time for self-reflection
____ Have your own personal psychotherapy
____ Write in a journal
____ Read literature that is unrelated to work
____ Do something at which you are not an expert or in charge
____ Decrease stress in your life
Source: Transforming the Pain: A Workbook on Vicarious Traumatization. Saakvitne, Pearlman & Staff of TSI/CAAP
(Norton, 1996)
____ Let others know different aspects of you
____ Notice your inner experience - listen to your thoughts, judgments, beliefs, attitudes, and
Feelings
____ Engage your intelligence in a new area (e.g. go to an art museum, history exhibit, sports
event, auction, theater performance
____ Practice receiving from others
____ Be curious
____ Say “no” to extra responsibilities sometimes
____ Other:
Emotional Self-Care
____ Spend time with others whose company you enjoy
____ Stay in contact with important people in your life
____ Give yourself affirmations, praise yourself
____ Love yourself
____ Re-read favorite books, re-view favorite movies
____ Identify comforting activities, objects, people, relationships, places and seek them out
____ Allow yourself to cry
____ Find things that make you laugh
____ Express your outrage in social action, letters and donations, marches, protests
____ Play with children
____ Other:
Spiritual Self-Care
____ Make time for reflection
____ Spend time with nature
____ Find a spiritual connection or community
____ Be open to inspiration
____ Cherish your optimism and hope
____ Be aware of nonmaterial aspects of life
Source: Transforming the Pain: A Workbook on Vicarious Traumatization. Saakvitne, Pearlman & Staff of TSI/CAAP
(Norton, 1996)
____ Try at times not to be in charge or the expert
____ Be open to not knowing
____ Identify what is meaningful to you and notice its place in your life
____ Meditate
____ Pray
____ Sing
____ Spend time with children
____ Have experiences of awe
____ Contribute to causes in which you believe
____ Read inspirational literature (talks, music, etc.)
____ Other:
Workplace or Professional Self-Care
____ Take a break during the workday (e.g. lunch)
____ Take time to chat with co-workers
____ Make quiet time to complete tasks
____ Identify projects or tasks that are exciting or rewarding
____ Set limits with your clients and colleagues
____ Balance your caseload so that no one day or part of a day is “too much”
____ Arrange your work space so it is comfortable and comforting
____ Get regular supervision or consultation
____ Negotiate for your needs (benefits, pay raise)
____ Have a peer support group
____ Develop a non-trauma area of professional interest
____ Other:
Balance
____ Strive for balance within your work life and work day
____ Strive for balance among work, family, relationships, play and rest
Source: Transforming the Pain: A Workbook on Vicarious Traumatization. Saakvitne, Pearlman & Staff of TSI/CAAP
(Norton, 1996)
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Self-Care Assessment Worksheet

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Completed 2 November 2020

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