WELLNESS INVENTORY
Please respond to the following items to find out your lifestyle “wellness”
quotient. There should be a numerical answer and sometimes a written
(confirmation) answer to help you clarify your answer.
Answer all the questions using the
following key:
0 = NO/Never
1 = SOMEWHAT/sometimes
2 = YES/frequently
OCCUPATIONAL
0
1
2
I have developed skills and strategies to deal with change in my life such as
___________________, _______________________and _____________________.
0
1
2
I have hobbies, interests, activities that bring me pleasure outside of my
academic or work such as:
0
1
2
I am comfortable with the direction of my future plans. My plans are:
0
1
2
I can balance my checkbook and I have a savings account to which I regularly
contribute.
0
1
2
I have 3 people who will or have written references for me. They are:
0
1
2
I find that the work I do contributes positively to who I am by providing
experience in:
0
1
2
I do not work solely for monetary rewards.
0
1
2
I am doing what I want to do with my life.
0
1
2
I am comfortable with growing older/gaining responsibility for myself.
Something that I am now responsible for is
0
1
2
I know of resources to answer questions about temporary jobs, internships &
and career oriented opportunities. These resources are:
OVERALL # ____/20
ADD 0’S __________ ADD 1’S _____________ ADD 2’S ______________
SPIRITUAL
0
1` 2
I have dreams/goals for my life. They
are_________________________________________.
0
1
2
I take time for spiritual growth which might include understanding other
religions: I grow spiritually by:
0
1
2
I am developing a personal philosophy of life. This includes clarifying values
and my purpose in life that may or may not be related to a specific religion
or may be related to reassessing my current religious beliefs.
0
1
2
I care about what happens to my fellow humans. I am concerned about
these issues:
___________________________________ and ___________________________________
0
1
2
I take time to think about the meaning of events in my life.
0
1
2
I am involved in a church, community service, school, or family project such
as
0
1
2
I have a clear sense of right and wrong. When there is dissonance
(difference) between my
beliefs and my behavior I do the following:
______________________________________________
0
1
2
I am comfortable with my beliefs and am willing to act on them even when
others do not believe as I do. I can give an example of a time when I
had to
stand up for my beliefs:
0
1
2
My spiritual thoughts occur in non-crisis times such as
_____________________________________.
0
1
2
I am able to explain what I believe in without being defensive.
OVERALL # ______/20
ADD 0’S_________ ADD 1’S__________
ADD 2’S ______
EMOTIONAL
0
1
2
I am seeing or would be willing to see a counselor for emotional concerns.
Maryville’s counselor is located. If unwilling to see a Counselor -Why?
0
1
2
I can say “no” when I need to without feeling guilty. I have had to say
NO to:
0
1
2
I seldom “lose control” when I an angry. I do the following instead
0
1
2
I am happy most of the time. Things/Situations/People that make me happy
are:
0
1
2
I have a number of people in my life whom I care for or call when I need them,
and who care for or call me when they need me. They are:
0
1
2
I feel comfortable with my sexual identity. If I had questions about my
sexuality or wanted to know more about the topic, I would do the following:
0
1
2
I recognize and prepare for events/situations which are likely to be stressful
to me. I do the following to reduce stress or prepare for stressful
events:
0
1
2
I am able to go where I want to go, do what I want to do without fear, shame
or
panic interfering with my activities.
0
1
2
I do not use drugs or alcohol to alter my emotions or if taking medication
prescribed by a physician, I am using the medication as
indicated and
participating in appropriate follow up.
0
1
2
I can name 5 things that I like about myself. They are
1.
2.
3.
4.
5.
OVERALL #______/20
ADD 0’S _______ ADD 1’S _______ ADD 2’S _______
PHYSICAL
0
1
2
I do not smoke
0
1
2
I do not get sick more that once or twice a year.
0
1
2
I maintain a healthy weight by practicing healthy eating habits (eating fruits
&
veg; meat/protein; dairy and grains
daily; and limiting non-nutritional foods
such as chips, candy, soda & alcohol. My diet
today: Morning
Midday
Evening
Snacks
0
1
2
I get between 6-10 hours sleep per day and feel rested when I awake.
0
1
2
I exercise vigorously for 15-30 minutes at least 3 times each week.
0
1
2
I do not drink alcohol when driving or I drink less than 2 drinks/day or I do
NOT drink if I
am pregnant or on medication or I am not 21 years of age
or just do not care to drink alcohol.
0
1
2
I engage in flexibility, strength and endurance types of exercise regularly.
0
1
2
I use a seatbelt every time I drive or am a passenger in a vehicle.
0
1
2
I know about my health/dental insurance, where to go for care & treatment
of disease
including sexually transmitted and where there are physical fitness activities
free of charge.
0
1
2
I always use a condom and birth control to safeguard against sexually
transmitted disease OR have had only one monogamous partner OR abstain from
sexual intercourse.
OVERALL # ___ /20
ADD 0’S ________ ADD 1’S _________ ADD 2’S
____________
SOCIAL
0
1
2
I have registered to vote and/or have voted in an election.
0
1
2
I can go to a party and have a good time without the use of drugs or alcohol.
0
1
2
I have friends/family with whom I can participate in activities I enjoy.
I enjoy
_________________________________________________________________________________.
0
1
2
I can resolve conflict through discussion &compromise and/or remove myself
from an illegal, dangerous or an uncomfortable situation.
0
1
2
I value time alone when I can
0
1
2
I am comfortable with people who do not look like me, who share different
beliefs or lifestyles or who are from another country or culture.
0
1
2
I contribute time or money to
_________________________________________________________.
0
1
2
I am knowledgeable and active about concerns in my community such as:
_________________________________________________________________________________.
0
1
2
I regularly keep abreast of local, national & international events by:
0
1
2
When I notice a safety hazard or environmental concern, I take action by
_________________________________________________________________________________.
OVERALL # __________/20 ADD
0’S ________ ADD 1’S ___________ ADD 2’S _________
INTELLECTUAL
0
1
2
I am comfortable with my time management skills and do not wait until the
last minute to
complete projects, rarely arrive late for appointments/work and have something
to do when I anticipate a wait of an extended length of time.
0
1
2
I know resources available to me on campus. Five resources available
are: 1.
2.
3.
4.
5.
0
1
2
I understand that considering diversity concerns and being aware of global
issues is important to my education and future work because
0
1
2
I feel that I can see more than one side of an issue. An issue that I
can see
the Pro/Con is:
0
1
2
I can explain clearly and simply to others what I know about something.
Explain “Wellness”
0
1
2
I have developed methods for helping me remember, organize my learning
or bring connections to my diverse learning. One method I use is
0
1
2
I recognize and value learning as a life-long process. I
___________________________________
in my spare time.
0
1
2
I understand how art/literature/music and or research increases
my intellectual growth. I utilize
______________________________________________________
to help with my intellectual growth.
0
1
2
I gather information from several sources before making a decision.
Sources
or processes include
_______________________________________________________________.
0
1
2
My words, behaviors and thoughts are consistent, not cognitively dissonant.
OVERALL # _________ ADD 0’S
__________ ADD 1’S __________ ADD 2’S _________
GRAND TOTALS:
ADD ALL 0’S ___________ 1’S ________________ 2’S
_______________ = _______________/120
IF your overall score of is 96 or >
Congratulations, you are leading a lifestyle that is at least 80% “WELL”!
If you received a score below 60, the Health and Wellness Office, Duchesne 176
has resources available to help you identify ways in which you might work
toward achieving greater balance and wellness in your life.