Benjamin Cummings: Fitness & Wellness WebSite

Body Self-Esteem Assessment

To print this activity, download it as a pdf file, lab11.pdf

Directions:
Using the scale, select the number alongside each body part or body function that represents your feelings about that part of yourself.

Scale:

1 = Have strong feelings and wish to change
2 = Do not like, but can tolerate
3 = have no particular feelings one way or the other
4 = Am satisfied
5 = Would not change and consider myself fortunate

Body Part or Function:

hair	1	2	3	4	5
appetite	1	2	3	4	5
shoulder width	1	2	3	4	5
hands	1	2	3	4	5
fingers	1	2	3	4	5
energy level	1	2	3	4	5
nose	1	2	3	4	5
waist	1	2	3	4	5
shape of head	1	2	3	4	5
wrists	1	2	3	4	5
ears	1	2	3	4	5
body build	1	2	3	4	5
back	1	2	3	4	5
weight	1	2	3	4	5
ankles	1	2	3	4	5
chin	1	2	3	4	5
profile	1	2	3	4	5
height	1	2	3	4	5
neck	1	2	3	4	5
chest	1	2	3	4	5
eyes	1	2	3	4	5
arms	1	2	3	4	5
lips	1	2	3	4	5
skin texture	1	2	3	4	5
hips	1	2	3	4	5
teeth	1	2	3	4	5
forehead	1	2	3	4	5
legs	1	2	3	4	5
voice	1	2	3	4	5
health	1	2	3	4	5
feet	1	2	3	4	5
posture	1	2	3	4	5
face	1	2	3	4	5
knees	1	2	3	4	5
facial complexion	1	2	3	4	5