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“Where Am I?” Self-Assessment

Welcome to our website and to the self-assessment component of our book,’ Stop Surviving – Live Your Life’. Before completing this self-assessment it is essential that you read the first part of Chapter 1, pages 12 to 20.

Instructions: Below is a questionnaire that asks about your life. This exercise will help you to understand ‘where you are’ in your life. Simply click on the spot which most resembles your response. It is important that you are HONEST.


Name:

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Email:

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Lifestyle Indices

A. Consumption habits

I consume: -

 

Not an Issue

     

Need to change

Too many fats and oils.

Too many sugary foods (cakes, sweets).

Not enough fruit and/or vegetables.

Too much junk food.

Too much alcohol.

Tobacco.

Excessive Caffeine.

Other Drugs.

I have a problem with: -

 

Not an Issue

     

Need to change

Being overweight/underweight.

High levels of cholesterol.

High or low blood pressure.

 

Yes

No

I have regular medical checkups.

 

B. Exercise

 

Not an Issue

     

Need to change

I do not obtain enough exercise.

My energy levels are low.

C. Sleep

 

Not an Issue

     

Need to change

I don't have enough sleep.

I have problems with my sleep patterns.

My bedroom is not suitable for sleep.

I think about work in bed.

I am not sufficiently relaxed before bed.

I wake up tired and lethargic.

D. Stress Management

 

Not an Issue

     

Need to change

I am stressed at home.

I am stressed at work.

I have difficulty relaxing.

I do not take rest breaks during the day.

I do not take holidays away from the home on a regular basis.

E. Housing

 

Not an Issue

     

Need to change

I don't feel comfortable and safe.

I do not like my house.

I do not have enough privacy.

I want to change where I live.

My house is too small/too big.

F. Work

 

Not an Issue

     

Need to change

I am unhappy doing what I am doing eg. career, voluntary work, being at home or raising children.

My 'personality' does not fit the work I do.

I am not rewarded appropriately (financially and intrinsically) for the work I do.

I am dissatisfied with my work/career.

I work too many hours per week.

I work too few hours per week.

G. Financial Security

 

Not an Issue

     

Need to change

My beliefs about money are negative.

I am in too much debt.

I do not enjoy my money.

I am not on target to achieve my long-term financial objectives.

I am addicted to gambling.

H. Intimate Relationship (Optional)

 

Not an Issue

     

Need to change

I have a troublesome relationship.

I place my partner’s needs ahead of my own.

I am not committed emotionally to my partner.

I cannot say ‘no’ without feeling guilty.

I am not happy with my sex life.

I wish to be in a relationship.

I. Parenting (Optional)

 

Not an Issue

     

Need to change

I am not a confident parent.

The discipline I use is not effective.

I don’t spend quality time with my children.

I don’t take enough ‘time out’ from my children.

J. Happy Home

 

Not an Issue

     

Need to change

I live in an unhappy home environment.

Communication is a problem at home.

My home life is not very stable.

K. Extended Family

 

Not an Issue

     

Need to change

My relationships with my broader family (including in-laws) are annoying.

We have problems with communication.

Many of my actions are motivated by a sense of obligation.

L. Friendship

 

Not an Issue

     

Need to change

I lack a reliable network of friends.

I lack one or two special friends.

I do not have time for new friendships.

I do not engage in clubs, community events and the neighbourhood.


Personal Fulfillment Indices

Learning

Usually open-minded

     

Usually subjective

Thinking

Usually positive

     

Usually negative

Usually rational

     

Usually irrational

Feeling

Usually expressive

     

Usually deny feelings

Usually carefree

     

Usually worried

Usually calm

     

Usually angry

Commitment

Usually committed

     

Usually not committed

Change

Usually flexible

     

Usually rigid

Usually take risks

     

Usually worried

Make choices easily

     

Uncomfortable making choices

Open to change

     

Fear change

Usually move on

     

Usually hold onto hurts

Usually forgiving

     

Usually unforgiving

Self - Management

Usually good time manager

     

Usually poor time manager

Usually goal oriented

     

Usually lack goals

Usually good communicator

     

Usually poor communicator

Usually good at listening

     

Usually poor at listening

Good empathy

     

Poor empathy

Inner Strength

Feel inner strength

     

Usually feel fear

Usually high self-esteem

     

Usually low self-esteem

Usually focused

     

Usually lack focus

Usually excited

     

Usually disinterested

Usually confident

     

Usually lack confidence

Usually self-loving

     

Usually self-doubting

Usually empowered

     

Usually disempowered

Self - Responsibility

Usually self-responsible

     

Usually blame others

Usually accountable

     

Usually self-pitying

Usually self-accepting

     

Usually seeking approval

Usually make own choices

     

Usually stuck and helpless

Live by my own values

     

Live by others' rules

Honour my true self

     

Ignore my gut feelings

Trust

Usually trusting

     

Usually distrusting

Usually reliable

     

Usually unreliable

Accepting of others

     

Not accepting of others

Usually open

     

Usually closed

Very honest

     

Not honest

Usually self-trusting

     

Low trust in self

Spirituality

Usually creative

     

Usually not creative

Usually spiritual

     

Usually non-spiritual

Happiness

Usually happy

     

Usually depressed

Usually giving

     

Usually taking

Usually Harmonious

     

Usually frustrated

Purpose

Have purpose

     

Lack purpose

Have meaning in life

     

No meaning in life

Gratitude

Usually grateful

     

Usually ungrateful

Appreciate nature

     

Usually ignore nature

 

Values

Assertiveness

 

Submissive

Assertive

Aggressive

I see myself being more:

Compassion

 

Cruel

Compassionate

Sentimental

I see myself being more:

Courtesy

 

Rude

Courteous

Servile

I see myself being more:

Enthusiasm

 

Apathetic

Enthusiastic

Over-the-top

I see myself being more:

Excellence

 

Ineffectual

Excellent

Perfectionist

I see myself being more:

Forgiveness

 

Blaming

Forgiving

Justifying

I see myself being more:

Friendliness

 

Hostile

Friendly

Sycophantic

I see myself being more:

Generosity

 

Selfish

Generous

Self-sacrificing

I see myself being more:

Honesty

 

Deceiving

Honest

Obvious

I see myself being more:

Humility

 

Pretentious

Humble

Humiliating

I see myself being more:

Joyfulness

 

Desperate

Joyful

Hysterical

I see myself being more:

Justice

 

Prejudicial

Fair

Self-righteous

I see myself being more:

Kindness

 

Malevolent

Kind

Interfering

I see myself being more:

Love

 

Loathing

Loving

Obsessed

I see myself being more:

Moderation

 

Indulgent

Moderate

Abstinent

I see myself being more:

Patience

 

Exasperated

Patient

Unresisting

I see myself being more:

Peacefulness

 

Strife-torn

Peaceful

Humdrum

I see myself being more:

Purposefulness

 

Aimless

Purposeful

Preoccupied

I see myself being more:

Reliability

 

Irresponsible

Reliable

Pedantic

I see myself being more:

Self-Discipline

 

Weak

Self-disciplined

Rigid

I see myself being more:

Tolerance

 

Narrow-minded

Tolerant

Gullible

I see myself being more:

You have now completed a full assessment of all your needs. Once you have submitted your answers, a Where-am-I Self-assessment Report will appear for you to read and/or print. This report provides you with a clear picture of where you are in your life. After you finish reading the report, resume reading the book from page 44, Chapter 1 and continue through the book. Once you reach Chapter 6, you will have the opportunity to complete another self-assessment so that you can make comparisons and see the changes that have occurred..

 

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