Self-Care Self-Assessment Question Title 1. What is your most common response in a stressful situation? Quick to respond - verbally Take 5: step away and practice deep breathing Respond with actions Question Title 2. Are you easily able to recognize your internal emotional state? Yes No Question Title 3. Have you practiced mindfulness in the last week? Yes No Question Title 4. Have you journaled in the last week to reflect on your emotions and internal state? Yes No Question Title 5. Do you find that your actions and habits in the last week align with your values and goals? Yes No Question Title 6. Do you meditate on a regular basis? Yes No Question Title 7. Have you practiced meal planning for the week? This can include any or all meals for the week. Yes No Question Title 8. Do you make time for your self on a weekly or monthly basis to do something you enjoy? Yes No Question Title 9. Do you make sure to get outside for at least 10-15 minutes each day? Yes No Question Title 10. Did you get at least six to eight hours of sleep on the majority of the days this week? Yes No Question Title 11. During the last week, did you say or write down any positive affirmations about yourself? Yes No Question Title 12. Do you regularly set yourself up for success by preparing things for the next day? This could include checking your schedule, setting your clothes out or prepping your meals. Yes No Question Title 13. Did you make your bed once in the last three days? Yes No Question Title 14. Do you get up and move your body at least once every hour? Yes No Question Title 15. Did you complete a workout you enjoy at least twice this week? Yes No Done