Burnout and Vicarious Trauma



Self-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 on to increase your level of self-care.

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My Physical Self-Care

4 = Frequently, 3 = Sometimes, 2 = Rarely, 1 = Never

1. ___ I eat regular meals (e.g. breakfast, lunch, and dinner)

2. ___ I eat healthy foods

3. ___ I exercise

4. ___ I get enough sleep

5. ___ I treat myself to massages and/or other pampering services

6. ___ I get regular preventative medical/dental care

7. ___ I get medical/dental treatment when needed

8. ___ I take time off when needed

9. ___ I dance, swim, walk, run, play sports, or do some other activity that I enjoy

10. ___ I take time for intimacy

Other things I do for physical self-care:

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My Mental Self-Care

4 = Frequently, 3 = Sometimes, 2 = Rarely, 1 = Never

1. ___ I read literature that is unrelated to work (or school)

2. ___ I do something at which I am not expert or in charge

3. ___ I pay attention to my inner thoughts, judgments, beliefs, attitudes, and feelings

4. ___ I take time to learn about topics I am interested in

5. ___ I engage my intelligence in new areas, (e.g. go to an art museum, history exhibit, sporting event, theater performance)

6. ___ I am curious about the world around me

7. ___ I take time for self-reflection

8. ___ I re-read favorite books, re-watch favorite movies

9. ___ I unplug, taking time away from technology, cell phones, computers, etc.

10. ___ I have my own personal therapist or life coach

Other things I do for mental self-care:

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My Environment

4 = Frequently, 3 = Sometimes, 2 = Rarely, 1 = Never

1. ___ My home feels peaceful and safe

2. ___ I acknowledge the beauty that surrounds me

3. ___ I surround myself with people and things that contribute to my peace of mind

4. ___ I avoid places and people that do not feel safe

5. ___ I support causes I believe in

6. ___ I do my part to make the world a better place

7. ___ I do my best to reduce my carbon footprint (recycle, upcycle, etc.)

8. ___ I pay attention to ingredients in the food I eat

9. ___ I avoid littering

10. ___ I avoid disposing of things that are bad for the environment

Other things I do for environmental health:

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My Emotional Self-Care

4 = Frequently, 3 = Sometimes, 2 = Rarely, 1 = Never

1. ___ I give myself affirmations and praise

2. ___ I show love to myself

3. ___ I identify comforting activities and seek them out

4. ___ I make an effort to create meaningful experiences and memories

5. ___ I allow myself to cry

6. ___ I set limits/boundaries with other people

7. ___ I find things that make me laugh

8. ___ I practice receiving from others

9. ___ I decrease stress in my life

10. ___ I write in a journal

Other things I do for emotional self-care:

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My Spiritual Self-Care

4 = Frequently, 3 = Sometimes, 2 = Rarely, 1 = Never

1. ___ I take time for reflection

2. ___ I embrace a spiritual connection or community

3. ___ I am open to inspiration

4. ___ I cherish optimism and hope

5. ___ I appreciate non-material aspects of life

6. ___ I am open to learning

7. ___ I identify what is meaningful to me and notice its place in my life

8. ___ I meditate and/or pray

9. ___ I have experiences of awe

10. ___ I read, watch, or listen to inspirational talks, music, etc.

Other things I do for spiritual self-care:

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My Social Self-Care

4 = Frequently, 3 = Sometimes, 2 = Rarely, 1 = Never

1. ___ I spend time visiting with close friends

2. ___ I take time to play

3. ___ I take breaks at work to talk to my coworkers

4. ___ I stay in contact with important people in my life

5. ___ I take day trips or mini-vacations

6. ___ I have a support network

7. ___ I spend time with others whose care about me

8. ___ I attend events: plays, movies, concerts, etc.

9. ___ I participate in activities with other people

10. ___ I let others see different aspects of myself

Other things I do for social self-care:

COMMIT TO PRACTICE SELF CARE

6 THINGS I WILL DO TO INCREASE MY SELF-CARE

(Choose 1 from each area above)

1. PHYSICAL:

I will

2. MENTAL:

I will

3. ENVIRONMENT:

I will

4. EMOTIONAL:

I will

5. SPIRITUAL:

I will

6. SOCIAL:

I will

Questions to consider as you begin your commitment(s):

Who is my support network?

How and when will I evaluate?

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