This assessment tool provides an overview of effective strategies to maintain self-care. After
completing the 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 regularly (e.g. breakfast, lunch and
dinner)
___ Eat healthy
___ Exercise
___ Get regular medical care for prevention
___ Get medical care when needed
___ Take time off when needed
___ Get massages
___ Dance, swim, walk, run, play sports, or do
some other physical activity that is fun
___ Take time to be sexual—with yourself, with a
partner
___ Get enough sleep
___ Wear clothes you like
___ Take day trips or mini-vacations
___ Other:
Psychological Self-Care
___ Make time for self-reflection
___ Have your own personal psychotherapy
___ Write in a journal
___ Read literature that is unrelated to school
___ 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, 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
___ 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
___ Have experiences of awe
___ Read inspirational literature (talks, music,
etc.)
___ Other:
