Caregiver Self-Care Checklist
Taking better care of yourself is important to you and everyone around you, especially if you are a caregiver. When you don’t practice self-care daily, you are not as healthy as you could be. This means you aren’t at your best, and you aren’t able to help others much.
To help you optimize or increase your self-care, fill in each section of this caregiver self-care assessment sheet to give you an idea of what you need to work on to feel better yourself and to be there for others.
For each of the following, rate how well you rate each item. Use the number system, with 1 being poor and 5 being the best. Write your score in the line by the item. Then, total up the numbers in each section and put them on the total score line by the section title.
Do not be discouraged by low numbers. Even if some area totals are no more than 10, at least you are doing something and now know of areas you need to work a bit more on.
Physical Self-Care – Total Score ________
___ I exercise 3-5 times a week.
___ I eat 3 healthy meals daily.
___ I eat nutritious snacks.
___ I follow a healthy sleep routine.
___ I avoid eating at fast food restaurants.
___ I visit my family doctor regularly.
___ I visit my dentist regularly.
___ I drink water for better hydration.
___ I incorporate weights in my exercises.
___ I take medications as prescribed.
I want/need to build/enhance these qualities:
__________________________________ _________________________________
__________________________________ _________________________________
Mental Self-Care – Total Score ________
___ I write in a journal regularly.
___ I keep up with current news & events.
___ I play cognitive games that challenge me.
___ I engage in at least one hobby a week.
___ I listen to relaxing music.
___ I call or write to keep in touch with people I care for.
___ I volunteer regularly.
___ I visit places that I enjoy at least twice a week.
___ I learn to do something new each week.
___ I practice self-compassion and acceptance.
I want/need to build/enhance these qualities:
__________________________________ _________________________________
__________________________________ _________________________________
Emotional Self-Care – Total Score ________
___ I journal about things that bother/worry me.
___ I talk about troubling thoughts with a trusted friend.
___ I make it a point to be kind to others.
___ I don’t take hurtful things to heart.
___ I listen to upbeat or sad music as needed.
___ I watch inspiring or funny movies/shows to cheer up.
___ I don’t allow my anger or frustration to affect others.
___ I read the news or books to keep my thoughts in perspective.
___ I tell people what I think in an appropriate way.
___ I effectively limit the time I spend with toxic people.
I want/need to build/enhance these qualities:
__________________________________ _________________________________
__________________________________ _________________________________
Social Self-Care – Total Score ________
___ I schedule one-on-one time for each person in my immediate family.
___ I participate in community events regularly.
___ I am part of several community groups.
___ I encourage my family and friends to try new things.
___ I check on my friends/family regularly.
___ I tell my friends and family why I appreciate them.
___ I effectively balance the time I need for myself and with others.
___ I ask for help when needed.
___ I offer help when I see another’s unfulfilled need.
___ I make new people feel welcome and valued.
I want/need to build/enhance these qualities:
__________________________________ _________________________________
__________________________________ _________________________________
Business Self-Care– Total Score ________
___ I arrive/begin work on time.
___ I work with a peer support group.
___ I work with others a team-player.
___ I compliment others on their work.
___ I follow the rules/instructions set for my job.
___ I read industry-related information regularly.
___ I regularly build and enhance my job skills.
___ I keep my desk/office clean and organized.
___ I take time off only when needed.
___ I take 15-minute breaks as required.
I want/need to build/enhance these qualities:
__________________________________ _________________________________
__________________________________ _________________________________
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