"Personal Wellbeing Assessment Checklist Template - Coaches Training Institute"

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Download "Personal Wellbeing Assessment Checklist Template - Coaches Training Institute"

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Name: ___________________
Email: ___________________
Phone: _____________________
This Assessment contains 9 areas that, together, represent one way of describing a whole life. This exercise measures your level of satisfaction
and range of expression in these areas as a snapshot in time. As you work through this assessment you will find areas where you can acknowledge
yourself for the success you have created and areas where you may want to improve your level of satisfaction. Rank each of the statements below
on a scale from 1 (Highly Disagree) to 10 (Highly Agree), then total your scores for each area.
Career (1 of 9)
Health and Wellbeing (6 of 9)
1 (Highly Disagree) to 10 (Highly Agree)
1 (Highly Disagree) to 10 (Highly Agree)
I love my work.
I approach my health in a proactive and generative way, rather
than crisis management mode.
I feel my talents and skills are well used in my work.
I am satisfied with my level of vitality and well being.
I enjoy my work environment and the people with whom I work.
I have support systems and structures in place that allow me to
I see opportunity for growth and development in my position.
easily maintain my health and well being.
I feel like I have found my right livelihood.
I am conscious of my body and fitness level and take
responsibility for my physical well-being.
Total
/50
I know what works for me to maintain my health and I
Fun and Recreation (2 of 9)
1 (Highly Disagree) to 10 (Highly Agree)
consistently do it.
I regularly take the time I need to experience play, adventure
Total
/50
and leisure.
Friends (7 of 9)
1 (Highly Disagree) to 10 (Highly Agree)
I know what activities renew me and bring me alive and I
participate in them regularly.
I have a sufficient number of great friends.
I create plenty of space in my life to relax and enjoy myself and
My friendships nourish and sustain me.
others.
I am a good friend and I make myself available to my
I create fun for myself and others.
friendships.
Total
/40
I trust the relationships I have with my friends.
Money and Finances (3 of 9)
I love and make the most of the time I spend with my friends.
1 (Highly Disagree) to 10 (Highly Agree)
Total
/50
I have enough money to do the things I want to do and to
accomplish the things that are important to me.
Family (8 of 9)
1 (Highly Disagree) to 10 (Highly Agree)
I manage my money and financial affairs and records well.
I am satisfied with the level of contact I have with my family.
I am free from worry and anxiety about money.
Nothing feels hidden or witheld in my relationships with family
My financial future feels robust and sustainable.
members.
Total
/40
I am satisfied with the role I play and the level of contribution I
have in my family.
Physical Environment (4 of 9)
1 (Highly Disagree) to 10 (Highly Agree)
I have created the experience of family in my life, whether or
I feel nourished and supported by my home.
not it is with my biological relatives.
I am surrounded by things that I love and have meaning to me.
Total
/40
The level of order in my surroundings is appropriate to my
Significant Other(9 of 9)
needs. (it serves me)
1 (Highly Disagree) to 10 (Highly Agree)
My wardrobe is a clear expression of who I am. I love being in
I am open to creating an intimate loving relationship.
the clothes I wear.
I am free from past resentments or blame in the area of intimate
Total
/40
relationships.
Personal Growth (5 of 9)
I am willing to risk myself for the sake of intimacy.
1 (Highly Disagree) to 10 (Highly Agree)
I create romance in my life.
I have a belief system that sustains me no matter what
circumstances life throws at me.
Total
/40
I am engaged in the unfolding story of my life and approach
each day as an adventure.
The Assessment Wheel was developed by the Coaches Training Institute.
I regularly experience living a life that I love and loving who I
am becoming.
I regularly engage in activities and learning that grow and
expand me.
Total
/40
Name: ___________________
Email: ___________________
Phone: _____________________
This Assessment contains 9 areas that, together, represent one way of describing a whole life. This exercise measures your level of satisfaction
and range of expression in these areas as a snapshot in time. As you work through this assessment you will find areas where you can acknowledge
yourself for the success you have created and areas where you may want to improve your level of satisfaction. Rank each of the statements below
on a scale from 1 (Highly Disagree) to 10 (Highly Agree), then total your scores for each area.
Career (1 of 9)
Health and Wellbeing (6 of 9)
1 (Highly Disagree) to 10 (Highly Agree)
1 (Highly Disagree) to 10 (Highly Agree)
I love my work.
I approach my health in a proactive and generative way, rather
than crisis management mode.
I feel my talents and skills are well used in my work.
I am satisfied with my level of vitality and well being.
I enjoy my work environment and the people with whom I work.
I have support systems and structures in place that allow me to
I see opportunity for growth and development in my position.
easily maintain my health and well being.
I feel like I have found my right livelihood.
I am conscious of my body and fitness level and take
responsibility for my physical well-being.
Total
/50
I know what works for me to maintain my health and I
Fun and Recreation (2 of 9)
1 (Highly Disagree) to 10 (Highly Agree)
consistently do it.
I regularly take the time I need to experience play, adventure
Total
/50
and leisure.
Friends (7 of 9)
1 (Highly Disagree) to 10 (Highly Agree)
I know what activities renew me and bring me alive and I
participate in them regularly.
I have a sufficient number of great friends.
I create plenty of space in my life to relax and enjoy myself and
My friendships nourish and sustain me.
others.
I am a good friend and I make myself available to my
I create fun for myself and others.
friendships.
Total
/40
I trust the relationships I have with my friends.
Money and Finances (3 of 9)
I love and make the most of the time I spend with my friends.
1 (Highly Disagree) to 10 (Highly Agree)
Total
/50
I have enough money to do the things I want to do and to
accomplish the things that are important to me.
Family (8 of 9)
1 (Highly Disagree) to 10 (Highly Agree)
I manage my money and financial affairs and records well.
I am satisfied with the level of contact I have with my family.
I am free from worry and anxiety about money.
Nothing feels hidden or witheld in my relationships with family
My financial future feels robust and sustainable.
members.
Total
/40
I am satisfied with the role I play and the level of contribution I
have in my family.
Physical Environment (4 of 9)
1 (Highly Disagree) to 10 (Highly Agree)
I have created the experience of family in my life, whether or
I feel nourished and supported by my home.
not it is with my biological relatives.
I am surrounded by things that I love and have meaning to me.
Total
/40
The level of order in my surroundings is appropriate to my
Significant Other(9 of 9)
needs. (it serves me)
1 (Highly Disagree) to 10 (Highly Agree)
My wardrobe is a clear expression of who I am. I love being in
I am open to creating an intimate loving relationship.
the clothes I wear.
I am free from past resentments or blame in the area of intimate
Total
/40
relationships.
Personal Growth (5 of 9)
I am willing to risk myself for the sake of intimacy.
1 (Highly Disagree) to 10 (Highly Agree)
I create romance in my life.
I have a belief system that sustains me no matter what
circumstances life throws at me.
Total
/40
I am engaged in the unfolding story of my life and approach
each day as an adventure.
The Assessment Wheel was developed by the Coaches Training Institute.
I regularly experience living a life that I love and loving who I
am becoming.
I regularly engage in activities and learning that grow and
expand me.
Total
/40
What area on the wheel are you most wanting and
To get a snapshot of your life, transfer your total scores from page one to the
summary Wheel of Life and find the % of the total for each area. Then take
willing to make a difference with?
that percent and draw a line in the respective area on the Wheel. Look at your
completed wheel. If your life is riding on this wheel, how bumpy is the ride? Answer
the questions on the right to help you expand your satisfaction and balance.
Summary:
Career
/50
=
%
Fun and Recreation
/40
=
%
Money and Finances
/40
=
%
What is the current state of this area in your life?
Physical Environment
/40
=
%
Personal Growth
/40
=
%
Health and Wellbeing
/50
=
%
Friends
/50
=
%
Family
/40
=
%
Significant Other
/40
=
%
What is missing or not working for you in this area?
What would you like to create in this area?
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