Self-Care & Self-Awareness

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Self-Care & Self-Awareness

On a scale of 1-5, check where you are for each statement. "1" means you need more information and are not ready at this time. "5" means you are ready and don't need to seek more information in this area.

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First Name and Last Name *

I know the difference in my performance when I am feeling well vs. feeling bad. *

I need more information and I am not ready at this time.

1

2

3

4

5

I am ready and don't need to seek more information in this area.

I have daily self-care strategies that I use at home and that I know help me. *

I need more information and I am not ready at this time.

1

2

3

4

5

I am ready and don't need to seek more information in this area.

I know ways to incorporate self-care at work. *

I need more information and I am not ready at this time.

1

2

3

4

5

I am ready and don't need to seek more information in this area.

I know what my limits are and how to advocate for myself. *

I need more information and I am not ready at this time.

1

2

3

4

5

I am ready and don't need to seek more information in this area.

I know what does NOT help me and what my triggers are. *

I need more information and I am not ready at this time.

1

2

3

4

5

I am ready and don't need to seek more information in this area.

I know how to avoid or respond to triggers.

*

I need more information and I am not ready at this time.

1

2

3

4

5

I am ready and don't need to seek more information in this area.

I know how to manage stress in my personal life so that it does not interfere with my work life. *

I need more information and I am not ready at this time.

1

2

3

4

5

I am ready and don't need to seek more information in this area.

I know when things are breaking down/when I need to involve someone and who to involve. *

I need more information and I am not ready at this time.

1

2

3

4

5

I am ready and don't need to seek more information in this area.

My supporters know how to help me when I’m nearing and/or in crisis. *

I need more information and I am not ready at this time.

1

2

3

4

5

I am ready and don't need to seek more information in this area.

I have a post-crisis plan which includes re-assuming work responsibilities. *

I need more information and I am not ready at this time.

1

2

3

4

5

I am ready and don't need to seek more information in this area.

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