Self-Care Assessment Worksheet



This assessment tool provides an overview of effective strategies to maintain self-care.  Due to busy schedules, it is easy for anyone to neglect certain areas of our life.  After compiling the full assessment, choose one item from each area that you will actively work to improve.  Printable versions are located at the bottom of this article.

Using the scale below, rate the following areas in terms of frequency:

5=Most all the time
1=It never occurred to me

Physical Self-Care

_____ Eat regularly (e.g., breakfast, lunch, and dinner).

_____ Eat healthy.

_____ Exercise.

_____ Get regular medical care when needed.

_____ Take time off when needed.

_____ Get massage.

_____ Swim, walk, run, play sports, sing, or do some other physical activity that is fun.

_____ Take time for sexual relationship.

_____ Get enough sleep.

_____ Take vacations.

_____ Take day trips or mini vacations.

_____ Make time away from cell phones.

_____ Freedom from all addictions.

_____ Spend quality time with your family.

_____ Other:________________________________


Psychological Self-Care

_____ Make time for self-reflection.

_____ Have your own personal psychotherapy.

_____ Write in a journal.

_____ Read literature that is unrelated to your work.

_____ Do something at which you are not an expert or in charge.

_____ Decrease stress in your life.

_____ Let others know different aspects of you.

_____ Notice your inner experience—listen to your thoughts, 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.

_____ Listen to music.

_____ Practice receiving from others.

_____ Be curious.

_____ Say “no” to extra responsibilities.

_____ Spend quality time with your family. Discover ways to improve your relationships.

_____ 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.

_____ Enjoy a hobby or activity that is stress-free.

_____ Wear clothes you like.

_____ Allow yourself to cry.

_____ Find things that make you laugh.

_____ Self-control by expressing your outrage in safe ways or settings, venting frustrations outside,
           with friends, or through written letters to people who have the power to change things.

_____ Laugh or play with children, donate your time to a non-profit organization.

_____ Promote joy over anxiety, joy over depression.

_____ Mentor someone.

_____ Spend quality time with your family.  Allow them to be an active part of your life.

_____ Other:____________________________________


Spiritual Self-Care

_____ Make time for prayer and reflection.

_____ Physically read or audibly listen to the Bible regularly.

_____ Listen to music throughout the day, openly sing and dance without reservation.

_____ Read motivational spiritual books other than for sermon preparation.

_____ Try at times to not be in charge, be open to receive, listen and look for something new.

_____ Be optimistic, hopeful, and reach beyond what you comprehend or feel. 

_____ Ask God to reveal something new in your life.

_____ Recall past spiritual highs, meditate how they were special and meaningful to you, and seek
           new spiritual highs.

_____ Be aware of nonmaterial aspects in your life.

_____ Contribute financially or donate your time with causes you believe in.

_____ Priority of God 1st, family 2nd, occupation 3rd

_____ Other:____________________________________


Workplace or Professional Self-Care

_____ Take a break during your workday (e.g., lunch, run an errand).

_____ Take time to interact with others either at work or in the community.

_____ Prioritize your tasks prior to the start of each day.

_____ Schedule quiet time to complete tasks.

_____ Do not allow people or calls to interfere with completing important goals or tasks.

_____ Have a support network with someone you can confidentially share issues with.

_____ Negotiate for your needs (salary & benefits).

_____ Arrange your workspace so it is comfortable and comforting.

_____ Delegate responsibilities to others.

_____ Develop and create a positive work environment.

_____ Carve out dedicated study time for sermon preparation each week without interruption.

_____ Schedule specific days for counseling, staff meetings, or any other task (e.g., Mondays for
           staff meetings, Tuesdays for counseling, Wednesdays for prayer and sermon preparation, etc.)

_____ Review your personal and church goals regularly.

_____ Revise goals as needed to objectively reach your goals.

_____ Ask for advice, feedback, or suggestions from time to time.

_____ Limit your work hours to include personal and family time.

_____ Maintain a goal or plan for your future and family needs (e.g., retirement, occupational change,
           family expectations)          

_____ Other:_____________________________



_____ Strive for balance within your work-life and workday.

_____ Strive for balance among God, work, family, relationships, play, and rest.


Printable Word Version
Self-Care Assessment Worksheet.docx
Microsoft Word document [17.2 KB]
Printable PDF Version
Self-Care Assessment Worksheet.pdf
Adobe Acrobat document [74.8 KB]

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