PERSONAL BALANCE CHECKLIST
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First Name:
Surname:
Email Address:
Telephone:
WORK
My work stimulates me
True
False
I am proud of what I do for a living
True
False
I feel appreciated in my workplace
True
False
I respect the people I work with
True
False
I know where my career is heading
True
False
I respond to calls and emails within 48 hours
True
False
I don't let paperwork pile up
True
False
I complete my work within reasonable hours
True
False
I manage my time well
True
False
I delegate without guilt
True
False
FINANCES
I am satisfied with my income
True
False
I have a budget that I use
True
False
I pay my bills on time
True
False
I know how much I owe and when it will be paid off
True
False
I have an active long-term financial plan
True
False
I am able to reward myself without feeling guilty
True
False
I use my credit card wisely
True
False
I have a will
True
False
My wallet is uncluttered
True
False
My tax affairs are up to date
True
False
HOME ENVIRONMENT
I am happy with my home
True
False
My home is generally clean and tidy
True
False
I surround myself with things that I love
True
False
I don't acquire clutter
True
False
I recycle at home
True
False
My personal files are in order
True
False
My bed supports me having a good sleep
True
False
My bed is always properly made
True
False
I have photos of loved ones on display
True
False
I am happy with my mode of transport
True
False
HEALTH AND BODY
I am happy with my current weight
True
False
I do some form of exercise at least three times a week
True
False
I have a balanced diet including lots of fresh food
True
False
I don't smoke or drink alcohol excessively
True
False
I drink at least 2 litres of water every day
True
False
I am up to date with all necessary medical and dental checkups
True
False
I am happy with the sleep I get
True
False
I have appropriate clothes for my work and personal interests
True
False
I am not concerned about my stress levels
True
False
I feel generally well
True
False
RELATIONSHIPS
I am happy with the level of intimacy in my life
True
False
My partner and I respect each other and are equals
True
False
I get along well with my work colleagues
True
False
I make amends easily with people I have had conflicts with
True
False
I trust the significant people in my life
True
False
I am on good speaking terms with my neighbours
True
False
I consider myself to be a good friend
True
False
I see people who are important to be regularly
True
False
My friends and family know how much I care about them
True
False
I am satisfied with my social life
True
False
PERSONAL
I like myself
True
False
I have had a birthday party in the last two years
True
False
I have a life outside of my work
True
False
I have enough confidence to do what I want in life
True
False
I have adequate holidays each year
True
False
I don't lie or exaggerate
True
False
I am comfortable saying no when I need to
True
False
People know they can count on me to do what I say I will do
True
False
I can easily recall the last time I really laughed
True
False
I have a form of creative expression
True
False
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filled in all parts of the form, including your name and email
address so the completed graph PDF can be returned to you.
Thank you.
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