Instructions
Reflect on how often you’ve engaged in the following self-care activities over the past two weeks.
Physical Wellbeing
1.
I get enough sleep and rest
Your answer:
Not at all
Rarely
Sometimes
Often
2.
I eat nourishing meals regularly
Your answer:
Not at all
Rarely
Sometimes
Often
3.
I move my body in ways that feel good
Your answer:
Not at all
Rarely
Sometimes
Often
4.
I limit caffeine, alcohol, and substances that affect my mood
Your answer:
Not at all
Rarely
Sometimes
Often
Emotional Wellbeing
1.
I allow myself to feel and express my emotions
Your answer:
Not at all
Rarely
Sometimes
Often
2.
I practise relaxation (e.g., deep breathing, warm baths, mindfulness)
Your answer:
Not at all
Rarely
Sometimes
Often
3.
I make time for fun and things I enjoy
Your answer:
Not at all
Rarely
Sometimes
Often
4.
I treat myself with kindness, especially when I’m struggling
Your answer:
Not at all
Rarely
Sometimes
Often
Social Wellbeing
1.
I spend time with people I care about
Your answer:
Not at all
Rarely
Sometimes
Often
2.
I feel supported by others when I need it
Your answer:
Not at all
Rarely
Sometimes
Often
3.
I communicate honestly and listen actively
Your answer:
Not at all
Rarely
Sometimes
Often
4.
I maintain healthy boundaries in relationships
Your answer:
Not at all
Rarely
Sometimes
Often
Mental Wellbeing
1.
I take breaks when I’m feeling mentally drained
Your answer:
Not at all
Rarely
Sometimes
Often
2.
I engage in hobbies or creative outlets
Your answer:
Not at all
Rarely
Sometimes
Often
3.
I set achievable goals and celebrate small wins
Your answer:
Not at all
Rarely
Sometimes
Often
4.
I stay present and limit time spent ruminating or doom-scrolling
Your answer:
Not at all
Rarely
Sometimes
Often
Spiritual Wellbeing
Spirituality can take many forms. For some, it’s found in religion or cultural traditions. For others, it might be a sense of connection to nature, creativity, or inner purpose.
1.
I feel connected to something greater than myself (nature, purpose, values, spirituality, etc.)
Your answer:
Not at all
Rarely
Sometimes
Often
2.
I reflect on what brings meaning to my life
Your answer:
Not at all
Rarely
Sometimes
Often
3.
I practise rituals or habits that help me feel grounded
Your answer:
Not at all
Rarely
Sometimes
Often
4.
I contribute to causes or communities I care about
Your answer:
Not at all
Rarely
Sometimes
Often