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Module 2: Initial Wellness Assessment

Upon completion learners will:
Complete initial assessment Understand all health risks Identify the need to maintain (M) or change(C), specific areas of wellness.

Module 2 will allow everyone to conduct an initial wellness assessment. The assessment tool provides participants with a generic outline describing their current wellness level. For the purpose of this class/presentation, the areas of wellness being addressed include: physical, emotional, psychological, and spiritual wellness. This picture is a representation of where you are currently. Pretend you are standing on the path. There is a path behind you and one in front of you. The path behind you is the past. The one in front is the future. The choice is yours. You can either choose to live in the past or begin to plan for the future. Look, even if you havent lived the best, or healthiest life, there is absolutely NOTHING you can do about that. Of course you could beat yourself up about it, but why? It will not change anything.

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The only thing you can change is what you do from this point forward. You must address previous bad decisions and poor choices, so you do not repeat them. Honestly, is there not one person in this room who does not regret a bad decision or a poor choice at some time in their lives? The choice did not have to be a total deal breaker, but think about how you felt when others got word of it. How did your loved ones react? Are you consumed with feelings of shame and guilt? Do you still carry around shame or embarrassment regarding the details of the incident? Why, because others feel you deserve it, or because you feel you deserve it? Can you change what happened? The answer: probably not. The key here is to make better choices from now on. You have to be open and honest and ready and willing to write a new ending.

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INITIAL WELLNESS ASSESSMENT 1. Gender: Male Female

2. Age:

____

3. Race:

American Indian/Alaskan Native Black/African American Other

Asian or Pacific Islander Hispanic/Latino

White/Caucasian

4. Ethnicity:

Hispanic Origin

Non-Hispanic Origin

5. Height:

_______

6. Weight:

___lbs.

7. Based on your height/weight ratio, are you: Underweight Overweight Average Unsure

8. Have you seen a health care provider in the past 12 months? Yes No

9. Do currently suffer from any physical injuries? Yes No

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10. Are you currently in pain?

Yes

No

11. Are you currently taking pain medication? Yes No

12. Are your immunizations current? Yes No Unsure

13. Are you current on checkups (i.e., dental visits, selfexams, and physicals)? Yes No Unsure

14. Do you brush your teeth at least twice a day? Yes No

15. Do floss your teeth daily?

Yes

No

16. Do you get at least 6 8 hours of restful sleep per night? Yes No

17. If you are NOT able to get 6 8 hours of restful sleep per night, why not? Please explain.

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18. Do you exercise 30 minutes at least 3 times per week? Yes No

19. Do you have high blood pressure? Yes No Unsure

20. Do you consume alcoholic beverages?

Yes

No

21. If yes, how many alcoholic beverages do you consume in a month? 1 -6 7-12 13 18 19+

22. Do you currently use tobacco products of any kind? Yes No

23. If you currently use tobacco, what form do you use?

24. Have you ever used any type of tobacco product? Yes No

25. Do you consume a balanced diet (i.e., whole grains, fruits, and vegetables) a majority of the time? Yes No

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26. How many times per week do you eat fast food? Never 1-3 4-6 7+

27. Do you drink 8-10 (8oz) glasses of water per day? Yes No

28. Do you wear your seatbelt ON-DUTY a majority of the time? Yes No

29. Do you wear a seatbelt OFF-DUTY a majority of the time? Yes No

30. Do you regularly wear bulletproof vest while ON-DUTY a majority of the time? Yes No I do not own a vest

31. Do you regularly follow policy and procedure when involved in high-risk behavior (i.e., vehicle pursuits, handcuffing, prisoner transport, searching suspects, hostage scenarios, etc.)? Yes No

32. If applicable, do you practice safe sex? Never Often Always Not applicable

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33. When in the sun, do you use sunscreen? Never Often Always

34. Do you suffer from personal or professional burnout? Yes No

35. Do you have an adequate support system? Yes No

36. Do you believe your life has purpose?

Yes

No

37. Do you seek assistance with issues you cannot resolve? Yes No

38. Do you possess adequate communication/problemsolving skills? Yes No

39. Are you able to control your emotions ON-DUTY? Yes No

40. Do you have a good sense of humor?

Yes

No

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41. Can you laugh at yourself?

Yes

No

42. Do you currently feel depressed?

Yes

No

43. Have you felt depressed within the last 12 months? Yes No

44. Do you know the signs and symptoms of depression? Yes No Unsure

45. Do you have a family history of mental illness? Yes No Unsure

46. Have you ever-contemplated suicide?

Yes

No

47. Do you currently feel emotionally balanced? Yes No

48. Do you feel loved by those closest to you? Yes No

49. Do you participate in extra-curricular activities/ hobbies in your free time? Yes No

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50. Do you have friends and connections outside of work? Yes No

51. In the past 12 months, have you experienced a major life-changing event (i.e., positive or negative)? Yes No

52. Do you consider yourself to be a spiritual person? Yes No Unsure

53. Do you plan intentional time alone in silence to clear your mind? Yes No

54. Can you easily convey to others the core beliefs in which you are building your life? Yes No

55. When in turmoil, do spiritual beliefs guide your actions? Yes No

56. Continuous development of my spiritual wellness is important? Yes No

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57. Do you possess positive coping mechanisms? Yes No Yes No

58. Do you have self-worth?

59. Does your life have purpose?

Yes

No

60. Are you more positive or negative at work? Positive Negative

61. Are you more positive or negative at home? Positive Negative

62. (In reference to the question above): If your responses are different (i.e., one positive and one negative), why is there a difference?

63. Are you in tune with your emotions/feelings/behaviors? Yes No

64. Do you have goals for the future?

Yes

No

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65. Have you made goals in the past?

Yes

No

66. Are you able to meet your goals/aspirations a majority of the time? Yes No

67. Do you feel that others expect too much from you? Yes No Unsure

68. Do you expect too much from yourself?

Yes

No

69. Do you often feel overwhelmed?

Yes

No

70. Do the majority of your relationships have meaning? Yes No

71. Do you have at least one person that you could confide in with anything? Yes No Unsure

72. Do you believe you are able to handle stress well? Yes No Yes No

73. Have you ever-contemplated suicide?

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74. Could you ever see suicide as a viable option? Yes No Unsure

75. If you answered yes to the question above, what would cause you to see suicide as a viable option?

The hard part is done. Now it is time for you to address only the areas highlighted in yellow. There are certain areas of the wellness assessment, which cannot be changed (e.g., your height, race, ethnicity, etc.). The yellow highlighted areas are areas, which can be changed. However, these will depend solely on your responses. Go back through the entire assessment and mark only the highlighted questions with (M) for maintain or (C) for change. For example: if you indicated drinking 19+ alcoholic beverages per month, it would be beneficial to your health to (C) change this pattern. The wellness assessment is strictly for your benefit. If for any reason you do not feel comfortable filling it out in class, please take it with you and complete it at a later time. The real key here is to be completely honest.