Self-Monitoring Behavior Form
Personal Information
Name
First Name
Last Name
Date of Birth
-
Month
-
Day
Year
Date
Email
example@example.com
Phone Number
Please enter a valid phone number.
Instructions
Please use this form to self-monitor and reflect on your behavior in various situations. Be honest and objective in your assessments. This form is intended for personal growth and development.
Behavior Categories:
Rate your behavior on a scale of 1 to 5 for each category, with 1 being the lowest and 5 being the highest.
Punctuality
Worst
1
2
3
4
Best
5
1 is Worst, 5 is Best
Communication with colleagues
Worst
1
2
3
4
Best
5
1 is Worst, 5 is Best
Meeting participation
Worst
1
2
3
4
Best
5
1 is Worst, 5 is Best
Adherence to workplace policies
Worst
1
2
3
4
Best
5
1 is Worst, 5 is Best
Communication with family and friends
Worst
1
2
3
4
Best
5
1 is Worst, 5 is Best
Supportiveness
Worst
1
2
3
4
Best
5
1 is Worst, 5 is Best
Active listening
Worst
1
2
3
4
Best
5
1 is Worst, 5 is Best
Conflict resolution
Worst
1
2
3
4
Best
5
1 is Worst, 5 is Best
Physical activity
Worst
1
2
3
4
Best
5
1 is Worst, 5 is Best
Nutrition
Worst
1
2
3
4
Best
5
1 is Worst, 5 is Best
Sleep habits
Worst
1
2
3
4
Best
5
1 is Worst, 5 is Best
Stress management
Worst
1
2
3
4
Best
5
1 is Worst, 5 is Best
Prioritization of tasks
Worst
1
2
3
4
Best
5
1 is Worst, 5 is Best
Meeting deadlines
Worst
1
2
3
4
Best
5
1 is Worst, 5 is Best
Minimizing procrastination
Worst
1
2
3
4
Best
5
1 is Worst, 5 is Best
Balancing work and personal time
Worst
1
2
3
4
Best
5
1 is Worst, 5 is Best
List behaviors you are proud of or that contribute positively to your personal and professional life.
Identify specific behaviors you aim to improve and set achievable goals.
Summary:
Reflect on overall patterns and trends in your behavior.
Consider strategies for maintaining positive behaviors and addressing areas for improvement.
Create an action plan outlining steps you will take to enhance positive behaviors and address areas for improvement.
Submit
Should be Empty: