Self-Care Inventory Form

Form
Sacred Self-Care Inventory
This worksheet is designed to help you assess and reflect upon your current self-care behaviors. Use the scale below to rate each item. There is no scoring or expectation that you should do all of these. When you are done, pay attention to the patterns in your responses and reflect on areas for improvement.

3 - Consistently

2 - Sometimes

1 - Rarely

0 - Never

Credit Line: "Sacred Self-Care Inventory" from Sacred Self-Care: Daily Practices for Nurturing Our Whole Selves by Chanequa Walker-Barnes. Copyright © 2023 by Chanequa Walker-Barnes. Used by permission of HarperCollins Publishers.
Your Email
example@example.com
Your City and State
Spiritual Self-Care

Focus on practices that nurture spiritual growth and connection
Devote time to prayer and scripture reading

3 - Consistently2 - Sometimes1 - Rarely0 - Never
Practice meditation or centering prayer

3 - Consistently2 - Sometimes1 - Rarely0 - Never
Participate in corporate worship or scripture study

3 - Consistently2 - Sometimes1 - Rarely0 - Never
Set aside a day for reflection and renewal

3 - Consistently2 - Sometimes1 - Rarely0 - Never
Take time to experience the beauty of God in nature

3 - Consistently2 - Sometimes1 - Rarely0 - Never
Participate in a spiritual community or peer group

3 - Consistently2 - Sometimes1 - Rarely0 - Never
Seek spiritual direction

3 - Consistently2 - Sometimes1 - Rarely0 - Never
Express gratitude for my blessings

3 - Consistently2 - Sometimes1 - Rarely0 - Never
Intentionally cultivate a forgiving disposition

3 - Consistently2 - Sometimes1 - Rarely0 - Never
Participate in a multiday retreat

3 - Consistently2 - Sometimes1 - Rarely0 - Never
Physical Self-Care

Centered on maintaining physical health and energy.
Drink at least 64 oz of water daily

3 - Consistently2 - Sometimes1 - Rarely0 - Never
Take time for meals each day

3 - Consistently2 - Sometimes1 - Rarely0 - Never
Eat in ways that are healthy for my body

3 - Consistently2 - Sometimes1 - Rarely0 - Never
Get at least 7 hours of sleep each night

3 - Consistently2 - Sometimes1 - Rarely0 - Never
Get 150 minutes of moderate vigorous exercise each week

3 - Consistently2 - Sometimes1 - Rarely0 - Never
Maintain a good balance of activity and rest

3 - Consistently2 - Sometimes1 - Rarely0 - Never
Notice and respond to my body’s signals (e.g., pain, fatigue, discomfort)

3 - Consistently2 - Sometimes1 - Rarely0 - Never
Have a good medical support team

3 - Consistently2 - Sometimes1 - Rarely0 - Never
Follow up with medical care

3 - Consistently2 - Sometimes1 - Rarely0 - Never
Properly manage any physical health conditions, illnesses, or disabilities

3 - Consistently2 - Sometimes1 - Rarely0 - Never
Try to accept and love my body

3 - Consistently2 - Sometimes1 - Rarely0 - Never
Emotional and Mental Self-Care

Addressing emotional well-being and mental resilience.
Laugh and have fun often

3 - Consistently2 - Sometimes1 - Rarely0 - Never
Find time to do things I enjoy

3 - Consistently2 - Sometimes1 - Rarely0 - Never
Engage in play and creativity

3 - Consistently2 - Sometimes1 - Rarely0 - Never
Participate in therapy

3 - Consistently2 - Sometimes1 - Rarely0 - Never
Journal

3 - Consistently2 - Sometimes1 - Rarely0 - Never
Practice positive self-talk

3 - Consistently2 - Sometimes1 - Rarely0 - Never
Say no and assert boundaries

3 - Consistently2 - Sometimes1 - Rarely0 - Never
Work at a reasonable pace

3 - Consistently2 - Sometimes1 - Rarely0 - Never
Refrain from overcommitting

3 - Consistently2 - Sometimes1 - Rarely0 - Never
Limit social media consumption

3 - Consistently2 - Sometimes1 - Rarely0 - Never
Acknowledge and accept positive and negative emotions

3 - Consistently2 - Sometimes1 - Rarely0 - Never
Appropriately manage mental health conditions, illnesses, and disabilities

3 - Consistently2 - Sometimes1 - Rarely0 - Never
Recognize when I am stressed and respond to it

3 - Consistently2 - Sometimes1 - Rarely0 - Never
Practice mindfulness meditation

3 - Consistently2 - Sometimes1 - Rarely0 - Never
Intellectual Self-Care

Encourages growth, curiosity, and lifelong learning.
Read books, magazines, or newspapers

3 - Consistently2 - Sometimes1 - Rarely0 - Never
Do puzzles

3 - Consistently2 - Sometimes1 - Rarely0 - Never
Learn or practice a new skill

3 - Consistently2 - Sometimes1 - Rarely0 - Never
Take a class

3 - Consistently2 - Sometimes1 - Rarely0 - Never
Watch documentaries or films that expose me to different cultures

3 - Consistently2 - Sometimes1 - Rarely0 - Never
Learn a language

3 - Consistently2 - Sometimes1 - Rarely0 - Never
Play word games or strategy games

3 - Consistently2 - Sometimes1 - Rarely0 - Never
Attend plays, museums, or cultural performances

3 - Consistently2 - Sometimes1 - Rarely0 - Never
Intentionally expose myself to different viewpoints

3 - Consistently2 - Sometimes1 - Rarely0 - Never
Take time for mental rest

3 - Consistently2 - Sometimes1 - Rarely0 - Never
Relational and Social Self-Care

Highlights healthy relationships and social connections.
Spend quality time with people whom I care about and who care about me

3 - Consistently2 - Sometimes1 - Rarely0 - Never
Have friendships based on mutual respect and reciprocity

3 - Consistently2 - Sometimes1 - Rarely0 - Never
Express gratitude to others

3 - Consistently2 - Sometimes1 - Rarely0 - Never
Give and receive compliments

3 - Consistently2 - Sometimes1 - Rarely0 - Never
Minimize contact with energy vampires

3 - Consistently2 - Sometimes1 - Rarely0 - Never
Be capable of asking for and receiving help from others

3 - Consistently2 - Sometimes1 - Rarely0 - Never
Have harmonious relationship with people I live and work with

3 - Consistently2 - Sometimes1 - Rarely0 - Never
Do fun things with other people

3 - Consistently2 - Sometimes1 - Rarely0 - Never
Reflection: What patterns did you notice in your responses? What areas are you doing well in, and where could you use improvement?
Should be Empty:

Form

Sacred Self-Care Inventory

Spiritual Self-Care

Physical Self-Care

Emotional and Mental Self-Care

Intellectual Self-Care

Relational and Social Self-Care