Download the worksheet (PDF)
What is the Self-Care Assessment worksheet?
The self-care assessment pdf gives clients a two-page rating grid that runs from Physical Self-Care through to Spiritual Self-Care. Each row pairs one Statement with a rating of 1 for rarely or never up to 5 for always. Sixteen statements fit inside a single session.
How to use the Self-Care Assessment worksheet
Use this sheet in session, reading each Statement aloud and letting the client answer without pausing to justify a number. Work down one domain at a time, since ratings flatten once a client starts scanning the whole grid. Finish with the two closing questions, which ask which area feels most satisfying and which needs the most improvement. Your clients can re-rate the same sheet a month later, which is where movement shows rather than in one sitting.
Self-Care Assessment Worksheet Download – What’s Included
The download is a two-page printable PDF and is not fillable, so ratings are marked by hand. Page one carries Physical, Emotional and Mental Self-Care; page two carries Social Self-Care and Spiritual Self-Care. Sixteen statements in all, each with a 1 to 5 rating column beside it. Page two closes with two open questions on the areas that feel strongest and weakest.
