Self-care is essential for maintaining healthy relationships. When we neglect our own needs, we may become depleted, resentful, or codependent. This worksheet will help you assess your current self-care practices, identify areas for improvement, and create a personalized self-care plan that supports your wellbeing and strengthens your relationships.

Print this worksheet or complete it digitally.

Part 1: Self-Care Assessment

Rate each statement on a scale of 1-5:

1 = Never true for me
2 = Rarely true for me
3 = Sometimes true for me
4 = Often true for me
5 = Almost always true for me

Physical Self-Care

1 5
1 5
1 5
1 5
1 5

Emotional Self-Care

1 5
1 5
1 5
1 5
1 5

Social Self-Care

1 5
1 5
1 5
1 5
1 5

Spiritual Self-Care

1 5
1 5
1 5
1 5
1 5

Intellectual Self-Care

1 5
1 5
1 5
1 5
1 5

Part 2: Self-Care Assessment Results

Transfer your totals from each section:

Interpreting Your Results:

100-125: Excellent self-care practices. You prioritize your wellbeing across multiple dimensions.

75-99: Good self-care with some areas for improvement. Focus on your lowest-scoring categories.

50-74: Moderate self-care. Dedicated attention to your lowest-scoring areas could significantly improve your wellbeing.

25-49: Self-care needs significant improvement. Consider seeking additional support to develop healthier self-care habits.

Below 25: Self-care is critically neglected. Prioritizing your wellbeing is essential for your health and relationships.

Part 3: Self-Care Barriers and Enablers

Identifying Barriers to Self-Care

Check all barriers that apply to you:

Identifying Self-Care Enablers

What resources, people, or circumstances help you practice self-care?

Part 4: Self-Care Activities Inventory

For each category, check activities you currently enjoy or would like to try, and add your own ideas:

Physical Self-Care Activities

Emotional Self-Care Activities

Social Self-Care Activities

Part 5: Creating Your Self-Care Plan

Based on your assessment results and activities inventory, create a personalized self-care plan:

Daily Self-Care Practices (5-15 minutes)

Choose 2-3 brief activities you can realistically incorporate into your daily routine:

Weekly Self-Care Practices (30+ minutes)

Choose 2-3 activities you can commit to on a weekly basis:

Monthly Self-Care Practices

Choose 1-2 more substantial activities to enjoy monthly:

Emergency Self-Care Plan

List activities, people, or resources you can turn to when feeling overwhelmed:

Part 6: Overcoming Self-Care Barriers

For each of your top three barriers to self-care, brainstorm potential solutions:

Tips for Common Self-Care Barriers

For guilt about self-care:

  • Remember that self-care enables you to be more present and effective in your relationships
  • Start with small acts of self-care to build comfort
  • Reframe self-care as necessary maintenance rather than luxury

For lack of time:

  • Schedule self-care activities in your calendar
  • Identify activities that can be integrated into existing routines
  • Start with 5-minute self-care breaks throughout the day

For difficulty saying no:

  • Practice saying "Let me check my schedule and get back to you"
  • Prepare simple scripts for declining requests
  • Remember that saying no to some things allows you to say yes to what matters most

Part 7: Self-Care Commitment

To solidify your commitment to self-care, complete the following statements:

Remember that self-care is not selfish—it's essential for your wellbeing and the health of your relationships. By taking care of yourself, you're better able to show up authentically and engage meaningfully with others. Be patient with yourself as you develop new self-care habits, and celebrate your progress along the way.

© Working for the Universe - Self-Care Planning Worksheet