Caregivers Self-Assessment Tool

Giving care to another person can be exhausting and overwhelming and those who are giving care to others often forget to pay attention to their own needs. This survey offers you an opportunity to assess your own level of stress and point out areas that may need attention. After you have thought about each item on the checklist, figure out which areas need more self care and build a care plan for yourself.


1. I get 7-9 uninterrupted hours of sleep each night.

2. I can fall asleep most nights without worry about my patient or my job.

3. Most people would describe me as a healthy eater.

4. I am able to get in at least 30 minutes of aerobic exercise, 4-6 days/week.

5. I do not have an unusual number of headaches.

6. I drink alcohol only in moderation, less than one drink/day.

7. My doctor is aware and approves of all of my medication, both prescribed and over-the-counter.


8. I am able to see the glass as half-full.

9. I rarely feel exhausted and drained of emotional energy.

10. I know how to drain stress away with healthy activities.

11. I know how to calm myself when I feel overwhelmed.

12. I am able to laugh at things and keep a healthy sense of humor.

13. I talk out loud when I am bothered by something rather than keeping it all inside.

14. I have a good support system with friends and family.

15. I have a good balance of leisure (play, fun, hobbies, travel, recreation) and work in my life.

16. Spirituality (art, beauty, music, nature, religion) nurture, support and replenish me.

17. Most of my relationships are healthy and supportive ones.

18. My work does not keep me from being a loving and appropriately giving partner, parent and/or friend.

19. I can be flexible with others' needs and ideas and do not think that my way is the only way.

20. I can manage with what I have to do and rarely feel overwhelmed.


21. I am able to be empathetic and supportive of the people that I work with.

22. I do not find myself becoming cynical or judgmental of my patients and coworkers.

23. My co-workers respect and appreciate me.

24. Generally, I am able to complete all of my work; when there is more than I can accomplish, I can prioritize or ask for help.

25. I know that I am in the right job and working in the right place.

26. I can leave work at work.

27. When I am faced with a crisis at work, I generally remain calm and can think clearly.

28. Family members would say that I have learned how to leave work at work and not bring the stress home.

29. I am good at staying on task, even when there are distractions.

30. I know when I need help and I ask for it when I need it.

31. I am pretty good at breaking tasks down and problem-solving.

Scoring: This assessment is for you to use to determine how effective you are at managing your own stress. Any "no" answer indicates a closer look at yourself and your self care.

Talk this over with someone else in your life who is willing to hold you accountable for caring for yourself. Find ways to make sure that you do not let others needs supersede your own care.

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