Ticked Bucket List Energy Tracker
Track your energy and manage your chronic pain effectively
Date:
Instructions
Please fill in the values for each section below on a scale of 1 to 10, where:
- 1 = Very Poor
- 10 = Excellent
Morning Assessment
Rate the quality of your sleep, considering duration, interruptions, and restfulness.
Evaluate the effectiveness of your pain management strategies in the morning after waking, with 1 being minimal relief and 10 being adequate pain relief.
Describe how energized you feel after waking up, from completely drained (1) to fully recharged (10).
Rate your ability to think straight, stay focused, and express yourself clearly in the morning, with 1 being extremely unclear and 10 crystal clear, sharp and focussed.
Assess your emotional state upon waking, from very low or anxious (1) to positive and calm (10).
Daily Activity and Symptom Check-In
Evaluate how much physical activity you performed, considering both intensity and duration.
Reflect on how mentally taxing your day was, with 1 being very demanding and 10 being light.
Rate the adequacy of rest breaks during the day, from none or minimal (1) to sufficient and refreshing (10).
Evaluate the effectiveness of your pain management strategies during the day, from minimal relief (1) to adequate pain relief (10).
Evaluate the quality of your meals and hydration, from poor or inconsistent (1) to balanced and nourishing (10).
Evening Reflection
Describe how much energy you have left at the end of the day, from completely drained (1) to still energetic (10).
Evaluate the effectiveness of your pain management strategies at the end of the day, from minimal relief (1) to adequate pain relief (10).
Evaluate how much time you dedicated to restorative activities, from none (1) to sufficient (10).
Reflect on your emotional state at the end of the day, from very low (1) to content and positive (10).
Rate your overall satisfaction with how the day went, from very dissatisfied (1) to highly satisfied (10).
Your Score
Disclaimer: This tool is for personal use only and should not replace professional medical advice. Consult your healthcare provider for medical concerns.