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Check-In Sheet: Feeling Rating 1 Rating 2
Check-In Sheet: Feeling Rating 1 Rating 2
Check-In Sheet
Check-In Sheet
Name Date
Regretful Angry Lonely Frightened Grieving Ashamed Nervous Aggressive Humiliated Withdrawn
Peaceful Disappointed Confident Guilty Jealous Hopeful Proud Grateful Enraged Calm
How intensely do you feel this way? Rate each feeling on a scale of 1-10.
After some time has passed or you’ve practiced your coping skills, check back in on your feelings
and rate them again to see how they have changed!
Feeling 1
10
5
Feeling 2
Feeling 3
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Last edited: 02/05/2020