A Free Resource from
Counseling LLC

Burnout & Emotional
Check-In Guide

A trauma-informed, culturally responsive tool for checking in with yourself — honestly, gently, and without judgment.

✦ Free Edition  ·  Fill Online  ·  Print & Keep
Begin Your Check-In
Date Name (optional)
Part One

Burnout Scale

Rate each statement honestly on a scale of 1–5. This is information, not judgment — just see where you are today.

How to use: 1 = Rarely / Not at all  →  5 = Almost always. All 10 questions reveal your total score.
—
Your Burnout Score (out of 50)
Part Two

Where Are You Carrying It?

Burnout and stress live in the body before they live in our words. Select every area where you've felt tension, heaviness, or discomfort lately.

Body Reflection
What does your body most need right now?
Physical Signs
What physical symptoms have you been minimizing or ignoring?
Part Three

Name What You're Feeling

Select all emotions present for you right now. There's no such thing as a wrong feeling — and you may feel many things at once.

Sit With It
Which emotion surprised you most to notice here?
What's Underneath
If this feeling could speak, what would it say?
Core Question
What are you most afraid to feel right now — and why might that be?
Part Four

What Do You Need?

High performers are often trained to need nothing. Check all that feel true — not what you "should" need, but what you actually need right now.

Barriers
What's making it hard to give yourself what you need?
One Small Step
What is ONE thing you could give yourself this week?
Part Five

Deeper Reflection

Take your time here. These questions invite you beneath the surface — with curiosity, not criticism.

Energy Audit
Where has your energy been going that doesn't align with what matters most to you?
The Mask
What version of yourself are you performing for others right now?
Real Self
Who are you when no one needs anything from you?
What's Working
What has been genuinely sustaining you lately — even in small ways?
Permission
What do you need permission to stop doing, feeling, or proving?
A Letter to Yourself
Write one sentence to the version of you that started today. What do they need to hear?
Part Six

Your Commitment

Not a to-do list. A gentle agreement with yourself about how you'll move forward — compassionately and honestly.

I commit to honoring myself by…

Fill this in and return to it whenever you forget what you chose for yourself today.

"You don't have to stay in survival mode. There is space here for you to feel again."

— InnerBeing Counseling LLC

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