CREATION Life Self Assessment

Goals – I regularly set and write down goals for the most important areas in my life.

1 - Poor

2 - Below Average

3 - Average

4 - Above Average

5 - Excellent

Discipline – I am good at delaying gratification until I achieve the goals I set.

1 - Poor

2 - Below Average

3 - Average

4 - Above Average

5 - Excellent

Habits – I am able to curb unhealthy habits and replace them with more beneficial alternatives.

1 - Poor

2 - Below Average

3 - Average

4 - Above Average

5 - Excellent

Balance – I recognize when my life is out of balance and effectively make changes to correct my actions and priorities.

1 - Poor

2 - Below Average

3 - Average

4 - Above Average

5 - Excellent

Mission – I have a personal mission statement that describes my values and guides the decisions I make on a daily basis.

1 - Poor

2 - Below Average

3 - Average

4 - Above Average

5 - Excellent

Sleep – I sleep soundly for 7-9 hours in a 24-hour period.

1 - Poor

2 - Below Average

3 - Average

4 - Above Average

5 - Excellent

Media – I make a conscious effort to limit screen time.

1 - Poor

2 - Below Average

3 - Average

4 - Above Average

5 - Excellent

Daily – I take adequate breaks throughout my workday.

1 - Poor

2 - Below Average

3 - Average

4 - Above Average

5 - Excellent

Weekly – I reserve one day a week to set aside my regular work and focus on rest, relationships and reflection.

1 - Poor

2 - Below Average

3 - Average

4 - Above Average

5 - Excellent

Yearly – At least once a year, I “get away” from my regular routine and experience relaxation and rejuvenation.

1 - Poor

2 - Below Average

3 - Average

4 - Above Average

5 - Excellent

Nature – I routinely engage in outdoor activities that allow me to enjoy nature, sunshine and fresh air.

1 - Poor

2 - Below Average

3 - Average

4 - Above Average

5 - Excellent

Clutter – My personal space (home, work, car, etc.) is organized and free of clutter.

1 - Poor

2 - Below Average

3 - Average

4 - Above Average

5 - Excellent

Home – My home environment gives me a sense of well-being.

1 - Poor

2 - Below Average

3 - Average

4 - Above Average

5 - Excellent

Sight – I have plants, pictures, art or other things in my personal space that bring me joy.

1 - Poor

2 - Below Average

3 - Average

4 - Above Average

5 - Excellent

Sound – I have found ways to bring peace to my personal space through music, nature or sometimes silence.

1 - Poor

2 - Below Average

3 - Average

4 - Above Average

5 - Excellent

Aerobic – I get 150+ minutes of cardio exercise throughout the week, such as walking, jogging, cycling, cardio machines or swimming.

1 - Poor

2 - Below Average

3 - Average

4 - Above Average

5 - Excellent

Strength – I have a muscle development routine, such as weightlifting, resistance bands, body weight exercises and core strengthening, that challenges me at least 3 times a week.

1 - Poor

2 - Below Average

3 - Average

4 - Above Average

5 - Excellent

Movement – I take opportunities to increase my movement throughout the day, such as taking stairs instead of the elevator, walking instead of driving and doing stretches.

1 - Poor

2 - Below Average

3 - Average

4 - Above Average

5 - Excellent

Mental Fitness – I work my mind by doing activities such as puzzles, reading, playing a musical instrument, enjoying a hobby or learning a new skill.

1 - Poor

2 - Below Average

3 - Average

4 - Above Average

5 - Excellent

Support – I have family or friends that support my activity goals and encourage me to follow through with my commitments. This may include an exercise partner who helps keep me accountable and makes my activity more enjoyable.

1 - Poor

2 - Below Average

3 - Average

4 - Above Average

5 - Excellent

Faith – I believe there is a Creator ultimately in control of the universe.

1 - Poor

2 - Below Average

3 - Average

4 - Above Average

5 - Excellent

Prayer – I talk honestly with God about my life, hopes, fears, desires and needs.

1 - Poor

2 - Below Average

3 - Average

4 - Above Average

5 - Excellent

Acceptance – I have peace knowing that God loves me, accepts me and is with me.

1 - Poor

2 - Below Average

3 - Average

4 - Above Average

5 - Excellent

Contemplation – I set aside time for personal spiritual development, such as praying, studying, meditating, praising or journaling.

1 - Poor

2 - Below Average

3 - Average

4 - Above Average

5 - Excellent

Fellowship – I participate in a faith community that supports my spiritual growth.

1 - Poor

2 - Below Average

3 - Average

4 - Above Average

5 - Excellent

Family – I have a good relationship with my family in which I give and receive love.

1 - Poor

2 - Below Average

3 - Average

4 - Above Average

5 - Excellent

Friendship – I have friends I enjoy and with whom I can be myself. I share my true thoughts and feelings with at least one close friend.

1 - Poor

2 - Below Average

3 - Average

4 - Above Average

5 - Excellent

Priorities – I do whatever it takes to nurture and grow the important relationships in my life.

1 - Poor

2 - Below Average

3 - Average

4 - Above Average

5 - Excellent

Forgiveness – When someone hurts me, I forgive them. When I hurt someone else, I am quick to seek their forgiveness.

1 - Poor

2 - Below Average

3 - Average

4 - Above Average

5 - Excellent

Outreach – I am involved in volunteer activities where I can serve others. This may include charity work, community service, spiritual outreach, etc.

1 - Poor

2 - Below Average

3 - Average

4 - Above Average

5 - Excellent

Attitude – I have a positive attitude that impacts the way I view life, the world and the people with whom I interact.

1 - Poor

2 - Below Average

3 - Average

4 - Above Average

5 - Excellent

Acceptance – I accept myself despite my faults and limitations.

1 - Poor

2 - Below Average

3 - Average

4 - Above Average

5 - Excellent

Responsibility – I take responsibility for my feelings and actions and do not blame others.

1 - Poor

2 - Below Average

3 - Average

4 - Above Average

5 - Excellent

Control – When I can’t control my circumstances, I am able to control my reaction or attitude toward them.

1 - Poor

2 - Below Average

3 - Average

4 - Above Average

5 - Excellent

Self-Compassion – I can forgive myself when I make a mistake or a poor choice.

1 - Poor

2 - Below Average

3 - Average

4 - Above Average

5 - Excellent

Perspective – I have a healthy and positive relationship with food.

1 - Poor

2 - Below Average

3 - Average

4 - Above Average

5 - Excellent

Colors – I regularly eat a wide variety of fruits and vegetables from all parts of the color spectrum and am aware of the nutritional value.

1 - Poor

2 - Below Average

3 - Average

4 - Above Average

5 - Excellent

Processed Food – I avoid processed and fast food whenever possible.

1 - Poor

2 - Below Average

3 - Average

4 - Above Average

5 - Excellent

Water – I drink at least 6-8 glasses of water every day.

1 - Poor

2 - Below Average

3 - Average

4 - Above Average

5 - Excellent

Weight – My body mass index (BMI) and my weight are within healthy guidelines.

1 - Poor

2 - Below Average

3 - Average

4 - Above Average

5 - Excellent

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