Lifestyle Choices – Personal Checklist
Read through the lifestyle choices listed below and put an X in the box by each one that
is something you do. Be honest in your assessment of your choices, no one else is
going to read your work, even your teacher. This checklist is to help you identify the
choices and habits you are making that are good, and those that are not so good. After
you have gone through the checklist and put an X in the box by those that apply to you.
Positive Lifestyle Choices (Put an X by each choice that applies to you MOST of the
time.)
Put an X
Lifestyle Choice
in the box
if this is
something
you do.
I make sure I get at least 8 hours of sleep
each night
I eat breakfast every day.
I eat 3 well balanced meals and 2 healthy
snacks a day.
I exercise at least 3x a week
I manage stress well by doing something
positive to relieve stress
I do not smoke tobacco or use tobacco
products
I do not drink or use illegal drugs
I drink plenty of water and stay away from
sugary drinks
I manage my time well, and make time for
exercise and relaxation
I have a good relationship with my family
I do not take unreasonable risks that put
myself or others in danger
I don’t let peer pressure push me into bad
decisions
Negative Lifestyle Choices (Put an X by each choice that applies to you MOST of the
time.)
Lifestyle Choice
I stay up late and often don’t get enough
sleep.
I skip breakfast, I don’t like to eat in the
morning
I eat a lot of fast food, I grab what’s
available or easy
I don’t exercise on a regular basis
I am stressed out a lot
I smoke tobacco or use tobacco products
I drink alcohol or sometimes use illegal
drugs (Smoking marijuana counts)
I don’t drink a lot of water
I don’t have time to exercise or relax, I
have too much too do
I don’t get along with my family very well,
we argue a lot and it’s stressful
I do take risks that I probably shouldn’t do
I let my friends influence a lot of the
decisions I make
Put an X
in the box
if this is
something
you do.