Self Care Inventory

• Go through the list below and check off ( √ ) each of the items that you are already performing.
• Uncheck any items that do not apply to you.
• Next, go through the list again and check off the “check box” of two (2) new behaviors that you are willing to initiate.
(In making your selections of new behaviors, you may want to select one easy one and one scary one.)
• Indicate the date you intend to include these behaviors.
• Create an action plan are you willing to initiate to establish the 2 new behaviors.
• Once the new behaviors are established, come back to the form and check them off and select two (2) more.

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