Self-Care Assessment Worksheet
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3Self-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
___
Get medical care when needed
___
Take time off when needed
___
Get massages
___
Dance, swim, walk, run, play sports, sing, 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 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 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)
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Parent category: Medical