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Personal Assessment
Use the icons in the upper right corner to save a pdf, print or email this page. Check an item if this is true for you at least 95% of the time. If the item does not represent a standard that you have for your life, simply cross it out. Answer truthfully and not what you think you "should" be doing. When you are done, total each section. Comparing the scores in each section will give you an overview of how closely your life is matching your "wished for" life. It will also focus you on which areas you may wish to develop further. Some people use the Clean Sweep as a self-coaching program by working to be able to check all items over time.
DATE: ___________________
SCORES: ______ WELL-BEING
______ SPIRITUALITY
______ MONEY
______ RELATIONSHIPS
______ PHYSICAL ENVIRONMENT
TOTAL
SCORE: ______
SECTION 1: WELL-BEING
1. __ I walk or exercise at least three times per week.
2. __ I have had a complete physical exam in the past 2 years.
3. __ My finger nails are healthy and look good.
4. __ I rarely use any caffeine (chocolate, coffee, colas, and tea less than 6 times per week).
5. __ I do not use illegal drugs or misuse prescribed medications.
6. __ I consistently take evenings, weekends and holidays off, and take at least 2 weeks of
vacation each year.
7. __ My weight is within an ideal range for a person of my height.
8. __ My blood pressure and cholesterol count is healthful.
9. __ I rarely miss work due to illness.
10. __ I have been to the dentist within the last 6 months for an exam.
11. __ I brush and floss my teeth daily.
12. __ I have had a complete eye exam within the past 2 years (Vision and Glaucoma check).
13. __ My hearing is good.
14. __ I rarely drink alcohol (no more than one glass of wine per day).
15. __ I rarely eat sugar (less than 3 times per week).
16. __ I rarely watch over 5 hours of television per week.
17. __ I have something to look forward to virtually every day.
18. __ I do not smoke or chew tobacco or other substances.
19. __ I have a rewarding life beyond my work or professional responsibilities.
20. __ I do not rush or rely on adrenaline to "get the job done".
SECTION 2: SPIRITUALITY
1. __ I maintain a consistent "Quiet Time" of prayer, meditation, and reflection.
2. __ I regularly attend corporate worship, or gather with others, in a faith community.
3. __ I meet regularly with a Spiritual Director, Mentor, Coach or Spiritual Elder.
4. __ I am current, and accountable, with a few close friends.
5. __ My personal experience of spirituality is growing and fulfilling.
6. __ I contribute financially to non-profit organizations.
7. __ I do not normally use profane or obscene language to express myself to others.
8. __ I give myself permission to explore various expressions of faith.
9. __ I read books and/or listen to tapes on Spirituality that stretch my own understandings, not
simply those that reinforce my own biases.
10. __ I feel that I am loved by God unconditionally.
11. __ I feel that people who do not share my own beliefs are equally loved by God.
12. __ I am using my personal time, gifts, talents, and/or financial resources to
assist others.
13. __ I am not afraid to share my personal beliefs with others in a non-threatening way.
14. __ I am not afraid to honor the personal beliefs that others share with me.
15. __ I feel personal accountability for the stewardship/care of nature, plants, and animals.
16. __ I often personally experience a sense of "awe" and/or "mystery" about life.
17. __ I am not personally afraid of dying, and view death as being a natural part of life.
18. __ I do not harbor any unresolved resentment, animosity or ill will toward others.
19. __ I believe I am a person of infinite worth.
20. __ I affirm all others as being persons of infinite worth, even when we disagree.
SECTION 3: MONEY
1. __ I currently save at least I0% of my income.
2. __ I virtually always pay my bills on time.
3. __ All of my tax returns have been filed, and all my taxes have been paid.
4. __ I have adequate medical insurance.
5. __ I rarely miss work because of illness.
6. __ I am currently paid-up, or have made adequate payment arrangements, on any money I
have borrowed from companies or individuals.
7. __ I am on a professional career-track which is, or will soon be, financially and
personally rewarding.
8. __ My income source is stable and predictable.
9. __ I regularly budget and live well within my means.
10. __ My will is up-to-date and accurate.
11. __ I have no "loose-ends" at work.
12. __ My financial situation does not keep me awake at night.
13. __ I know how much I am currently worth financially.
14. __ All child-support, alimony, and/or parking tickets are paid-up and current.
15. __ There are no legal clouds hanging over me.
16. __ I have a realistic personal financial plan for the next one to five years.
17. __ My earnings consistently outpace the annual rate of inflation.
18. __ My personal assets (e.g. home, auto, possessions, treasures) are adequately insured.
19. __ I have at least 6 months' living expenses set-aside in a money-market-type account.
20. __ I am in relationship with others who can assist in my career/professional development.
SECTION 4: RELATIONSHIPS
1. __ I do not gossip or talk negatively about others.
2. __ I have a circle of friends/family who love and appreciate me for who I am, more than just
what I do.
3. __ There is no one whom I would dread or feel uncomfortable "running into" at a party,
airport terminal, or on the street.
4. __ I set good emotional boundaries, and do not "take personally" the things people say to me.
5. __ I have a best friend or soul mate to intimately share things with and confide in.
6. __ I quickly correct miscommunications and misunderstandings when they occur.
7. __ I am a person of my word; people can count on me to mean what I say.
8. __ I am complete with past loves or spouses.
9. __ I make requests of others rather than complain.
10. __ I get along well with my co-workers, clients and/or staff.
11. __ I intentionally maintain a personal and professional network that I seek to nourish.
12. __ I send at least 5 hand-written notes to people each week.
13. __ I return telephone calls within 24 hours.
14. __ I regularly tell my parents, siblings, children, and spouse/significant other that I love
them.
15. __ I virtually always put people first and results second.
16. __ I always tell the truth as I know it to be, no matter what.
17. __ I communicate, or attempt to communicate, with everyone whom I have damaged,
injured, or seriously upset, whether or not doing so was my intention or fault.
18. __ I tell others, specifically, how they can assist me in meeting my needs and/or goals.
19. __ I do not inappropriately express anger or rage toward others.
20. __ I seek to attract others, rather than "sell" or "manipulate" them to do my bidding.
SECTION 5: PHYSICAL ENVIRONMENT
1. __ My personal files, papers and receipts are neatly filed away.
2. __ My car is in excellent condition. (Does not need mechanical work, repairs, cleaning, or
replacing).
3. __ My clothes are pressed, clean, well-fitting, and make me look great.
4. __ People report feeling comfortable in my home.
5. __ I live in a home/apartment that I love.
6. __ My plants and animals are healthy. (Fed, shots, watered, getting light and love).
7. __ I have nothing in my house or in storage that I do not need.
8. __ I live in the geographic area of my choice.
9. __ My work environment is productive and inspiring.
10. __ I surround myself with beautiful things, appropriate to my income level, without being
ostentatious, superficial or flashy.
11. __ There is ample and healthy lighting around me.
12. __ I practice recycling.
13. __ My bed is made daily.
14. __ I drink purified water.
15. __ I am consistently early or on time.
16. __ My home is neat and clean (vacuumed carpets, clean closets, furnishings in good
repair).
17. __ I am not tolerating anything about my home or work environment.
18. __ I surround myself with music and art that makes my life more enjoyable.
19. __ My appliances, machinery and equipment work well (refrigerator, snow blower, lawn
mower, water heater, toys, electronic devices, etc.)
20. __ I do not injure myself, fall, or bump into things.
Congratulations - You've made it!
Scoring: Total all of your scores for each section and record them at the top.
Click here to see how you can use this information to improve your life. Based on material from Thomas Leonard, Coachville, 2001.
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