Oregon



Self-Care in Your Personal Life QuestionnaireInstructions: Please rate each of the items, on the 0-3 scale, in terms of how often you use them in your personal life. Look at what you actually do, rather than what you think you should do.Physical Self-Care0123Eat regularly and healthilyGet regular exercise & maintain fitnessGet enough sleep (an average of 8 or more hours per day)Take time for yourselfGet regular medical & dental preventative careScoreCognitive Self-Care0123Take time for self-reflectionRecognize and value your strengths, capabilities and accomplishmentsDiscuss and exchange thoughts and ideas with othersEncourage yourself to be actively curious and interestedRead books or material that have nothing to do with workScorePsychological/Emotional Self-Care0123Listen to your internal experience (e.g., feelings, thoughts, beliefs, judgments, etc.)Allow yourself to experience distressing emotionsMake space and opportunities for laughter and funActively work to reduce your stress levelsMake opportunities to safely connect with others and be yourselfScoreBehavioral Self-Care0123Ask for support and assistance when you need itDo things where you are not an expert or not in chargeStop added responsibilities & stressesEngage in hobbies or interest that are not work-relatedGive yourself day-trips, mini vacations or breaks from the routineScoreInterpersonal Self-Care0123Make time for your intimate relationshipSpend quality time with children & family membersSpend time with friends who are important to youTake risks in letting people know different aspects of youSet limits to taking on responsibilities and burdens that are not yoursScore ................
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