Personal Wellbeing Assessment Checklist Template printable pdf download

Name: ___________________

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This Assessment contains 9 areas that, together, represent one way of describing a whole life. This exercise measures your level of satisfaction

and range of expression in these areas as a snapshot in time. As you work through this assessment you will ﬁnd areas where you can acknowledge

yourself for the success you have created and areas where you may want to improve your level of satisfaction. Rank each of the statements below

on a scale from 1 (Highly Disagree) to 10 (Highly Agree), then total your scores for each area.

Career (1 of 9)

Health and Wellbeing (6 of 9)

1 (Highly Disagree) to 10 (Highly Agree)

I love my work.

I approach my health in a proactive and generative way, rather

than crisis management mode.

I feel my talents and skills are well used in my work.

I am satisﬁed with my level of vitality and well being.

I enjoy my work environment and the people with whom I work.

I have support systems and structures in place that allow me to

I see opportunity for growth and development in my position.

easily maintain my health and well being.

I feel like I have found my right livelihood.

I am conscious of my body and ﬁtness level and take

responsibility for my physical well-being.

Total

/50

I know what works for me to maintain my health and I

Fun and Recreation (2 of 9)

1 (Highly Disagree) to 10 (Highly Agree)

consistently do it.

I regularly take the time I need to experience play, adventure

Total

/50

and leisure.

Friends (7 of 9)

1 (Highly Disagree) to 10 (Highly Agree)

I know what activities renew me and bring me alive and I

participate in them regularly.

I have a sufﬁcient number of great friends.

I create plenty of space in my life to relax and enjoy myself and

My friendships nourish and sustain me.

others.

I am a good friend and I make myself available to my

I create fun for myself and others.

friendships.

Total

/40

I trust the relationships I have with my friends.

Money and Finances (3 of 9)

I love and make the most of the time I spend with my friends.

1 (Highly Disagree) to 10 (Highly Agree)

Total

/50

I have enough money to do the things I want to do and to

accomplish the things that are important to me.

Family (8 of 9)

1 (Highly Disagree) to 10 (Highly Agree)

I manage my money and ﬁnancial affairs and records well.

I am satisﬁed with the level of contact I have with my family.

I am free from worry and anxiety about money.

Nothing feels hidden or witheld in my relationships with family

My ﬁnancial future feels robust and sustainable.

members.

Total

/40

I am satisﬁed with the role I play and the level of contribution I

have in my family.

Physical Environment (4 of 9)

1 (Highly Disagree) to 10 (Highly Agree)

I have created the experience of family in my life, whether or

I feel nourished and supported by my home.

not it is with my biological relatives.

I am surrounded by things that I love and have meaning to me.

Total

/40

The level of order in my surroundings is appropriate to my

Signiﬁcant Other(9 of 9)

needs. (it serves me)

1 (Highly Disagree) to 10 (Highly Agree)

My wardrobe is a clear expression of who I am. I love being in

I am open to creating an intimate loving relationship.

the clothes I wear.

I am free from past resentments or blame in the area of intimate

Total

/40

relationships.

Personal Growth (5 of 9)

I am willing to risk myself for the sake of intimacy.

1 (Highly Disagree) to 10 (Highly Agree)

I create romance in my life.

I have a belief system that sustains me no matter what

circumstances life throws at me.

Total

/40

I am engaged in the unfolding story of my life and approach

each day as an adventure.

The Assessment Wheel was developed by the Coaches Training Institute.

I regularly experience living a life that I love and loving who I

am becoming.

I regularly engage in activities and learning that grow and

expand me.

Total

/40

Personal Wellbeing Assessment Checklist Template

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