check

Are you Running on Empty? Self-Assessment

This self-assessment is for caregivers and over committers who want to check in on their energy and well-being.

Rating scale:
0 = Never / Not at all
1 = Rarely
2 = Sometimes
3 = Often
4 = Very often

Answer each question honestly, then total your score to see what it might be telling you about your current level of depletion. At the end you will want your total score. 

Click the button below to start.

Start

Question 1 of 15

1. I feel responsible for everyone else's well-being.

A

0 - Never/Not at all

B

1 - Rarely

C

2 - Sometimes

D

3 - Often

E

4 - Very Often

Question 2 of 15

2. I have difficulty saying no.

A

0 – Never / Not at all

B

1 - Rarely

C

2 - Sometimes

D

3 - Often

E

4 - Very Often

Question 3 of 15

3. I feel guilty when I take time for myself.

A

0 – Never / Not at all

B

1 - Rarely

C

2 - Sometimes

D

3 - Often

E

4 - Very Often

Question 4 of 15

4. My own needs often come last.

A

0 – Never / Not at all

B

1 - Rarely

C

2 - Sometimes

D

3 - Often

E

4 - Very Often

Question 5 of 15

5. I feel physically exhausted most days.

A

0 – Never / Not at all

B

1 - Rarely

C

2 - Sometimes

D

3 - Often

E

4 - Very Often

Question 6 of 15

6. I rarely make time for activities I enjoy.

A

0 – Never / Not at all

B

1 - Rarely

C

2 - Sometimes

D

3 - Often

E

4 - Very Often

Question 7 of 15

7. I feel overwhelmed by my responsibilities.

A

0 – Never / Not at all

B

1 - Rarely

C

2 - Sometimes

D

3 - Often

E

4 - Very Often

Question 8 of 15

8. I wake up already feeling tired.

A

0 – Never / Not at all

B

1 - Rarely

C

2 - Sometimes

D

3 - Often

E

4 - Very Often

Question 9 of 15

9. I feel resentful but keep pushing through.

A

0 – Never / Not at all

B

1 - Rarely

C

2 - Sometimes

D

3 - Often

E

4 - Very Often

Question 10 of 15

10. I ignore my body's signals for rest

A

0 - Never/Not at all

B

1 - Rarely

C

2- Sometimes

D

3 - Often

E

4 - Very Often

Question 11 of 15

 11. I struggle to ask for help

A

0 - Never/ Not at all

B

1 - Rarely

C

2 - Sometimes

D

3 - Often

E

4 - Very Often

Question 12 of 15

12. I feel like i have to hold everything together.

A

0 - Never/ Not at all

B

1 - Rarely

C

2 - Sometimes

D

3 - Often

E

4 - Very Often

Question 13 of 15

13. I put off my own appointments or self-care.

A

0 - Never/ Not at all

B

1 - Rarely

C

2 - Sometimes

D

3 - Often

E

4 - Very Often

Question 14 of 15

14. I am so busy taking care of others that I don't recognize myself when I stop.

A

0 - Never/ Not at all

B

1 - Rarely

C

2 - Sometimes

D

4 - Often

E

5 - Very Often

Question 15 of 15

15. I often think, "I'll take care of myself later."

A

0 - Never/ Not at all

B

1 - Rarely

C

2 - Sometimes

D

3 - Often

E

4 - Very Often

Confirm and Submit