Check-in Assessment
when is the last time you took a shower?
Today
Yesterday
2 days ago
3+ days ago
can't remember
which sentiments do you agree with right now?
I am incapable of taking care of myself without great effort.
I am losing control over my ability to contain emotional outbursts
I am becoming overwhelmed over little things
My academic workload is causing me stress
My personal life is causing me stress
I feel physically ill and I believe this is due to mental factors
I have/would like to self-harm
I feel suicidal
I have reoccurring suicidal thoughts
I have mentally considered the logistics of committing suicide
how many meals have you had in the last 48 hours?
5-6
3-4
0-2
on a scale of 1-10, rate your current mental state.
1
2
3
4
5
6
7
8
9
10
have you had water OR a water-based drink like sparkling water in the last 48 hours?
Yes
No
Yes but not enough of it
which of these healthy behaviors have you done in the past week?
Ate a healthy meal at least once a day
Brushed teeth daily at least 2 times
Done a skincare routine
Had physical contact with a loved one
Had a good night's sleep
Woke feeling rested most days
Felt capable of handling classwork most days
Felt inspired, creative, or excited about something
Done something active some/most days
Gone outside to spend time in nature
Gone off-campus
Had a meal outside of my room
Gotten through the day without a nap
Been on-time and attended school consistently
Been on-time and attended work consistently
Checked in with the family via message or video chat
Did a fun activity such as baking, journaling, drawing, video games, etc
Kept my room clean most days
which of these unhealthy behaviors have you done in the past week?
Canceled plans or didn't show up when I was supposed to
Avoided showering until my hair got so greasy I couldn't hide it
Ran out of laundry or let trash pile up
Slept during the day at inappropriate times
Fell behind on schoolwork/readings
Needed to ask for an assignment extension
Procrastinated on assignments until the last minute
Avoided loved ones or pushed away help
Purposefully gone hungry due to inability to leave room/self punishment
Left food trash in my room
Caused my room to smell bad because of lack of cleaning
Worn the same outfit multiple days in a row without changing
Had severe nightmares
Had a meltdown
Was unable to control hand flaps, angry outbursts, or crying
what emotions are present?
anger
sadness
regret
guilt
anxiety
hurt
lack of motivation
overwhelmed
hopeless
dread
irritation
emptiness
loneliness
{"name":"Check-in Assessment", "url":"https://www.quiz-maker.com/QQ62X345C","txt":"when is the last time you took a shower?, which sentiments do you agree with right now?, how many meals have you had in the last 48 hours?","img":"https://www.quiz-maker.com/3012/images/ogquiz.png"}