1. KPI’s Worksheet
This worksheet is going to look at the 8 components in your life that are directly
related to your health, fitness and wellness.
Each component will have 10 things for you to assess. There are no right or wrong
answers. This process may give you some vital clues to areas in your life that may
need to change in order to improve your health, fitness and wellness.
Be honest and truthful, even when your answer is embarrassing or painful.
Remember, no one else needs to see this sheet and that you won’t improve your
health, fitness and wellness by deceiving yourself.
Rate the following on the scale from 1 to 5, 1 being least true and 5 being most true.
Mindset Component
1 I’m a person who sets goals. 1 2 3 4 5
2 Once a goal is established I get focused. 1 2 3 4 5
3 I always have a strong vision of what my goal looks like. 1 2 3 4 5
4 Once I set a goal I get enthusiastic, and motivated. 1 2 3 4 5
5 I can commit to a goal of looking good and feeling good. 1 2 3 4 5
6 I normally achieve my goals. 1 2 3 4 5
7 When I set a goal I take action and follow through with it. 1 2 3 4 5
8 I have a mentor to guide me through good and bad times. 1 2 3 4 5
9 I engage in self-development activities. 1 2 3 4 5
10 My thoughts are always positive. 1 2 3 4 5
Relationship Component
1 My friends or family give great support when I set goals. 1 2 3 4 5
2 There are people around me who are an inspiration 1 2 3 4 5
3 I spend quality time with my friends or family. 1 2 3 4 5
4 I am aware of other people’s feelings. 1 2 3 4 5
5 I don’t get nervous being around people who I don’t know. 1 2 3 4 5
6 I easily make friends. 1 2 3 4 5
7 Friends and family can rely on my honesty. 1 2 3 4 5
8 I have a good relationship with myself. 1 2 3 4 5
9 People around me are positive. 1 2 3 4 5
10 I can maintain satisfying relationship with others. 1 2 3 4 5

2. Image Component
1 I love what I see when I look in the mirror. 1 2 3 4 5
2 I don’t cover up in front of my partner. 1 2 3 4 5
3 Clothes always look good on me. 1 2 3 4 5
4 I can walk into any clothes shop and easily find clothes I like. 1 2 3 4 5
5 When I wear new clothes I look good and feel good. 1 2 3 4 5
6 I always look good when I go out e.g. movie, bar, café. 1 2 3 4 5
7 I am full of confidence when I’m at a public place. 1 2 3 4 5
8 It feels good when people say I look good. 1 2 3 4 5
9 I’m not pressured by super models to change my body shape. 1 2 3 4 5
10 I have great self-esteem. 1 2 3 4 5
Body Component
1 Working out makes me feel good. 1 2 3 4 5
2 I workout for 45 minutes 5 days per week. 1 2 3 4 5
3 When I finish my workout it feels like I’ve done a workout. 1 2 3 4 5
4 I’m hydrated when I workout. 1 2 3 4 5
5 I never workout on an empty stomach. 1 2 3 4 5
6 I don’t have any health related conditions e.g. Type 2 diabetes 1 2 3 4 5
7 Over the years I’ve never been one to stop and start exercise. 1 2 3 4 5
8 I organize my life around my exercise. 1 2 3 4 5
9 I never find excuses to why I shouldn’t workout. 1 2 3 4 5
10 I don’t have niggling injuries that stop me from exercising. 1 2 3 4 5
Emotion Component
1 I take responsibility of my own actions. 1 2 3 4 5
2 I do things to keep myself in a positive mindset. 1 2 3 4 5
3 I take ownership of my health, fitness and wellness 1 2 3 4 5
4 I don’t isolate myself from others when I’m down. 1 2 3 4 5
5 I see obstacles as opportunities for personal growth. 1 2 3 4 5
6 I feel I have considerable control of my life in general. 1 2 3 4 5
7 I can recognize my shortcomings and learn from my mistakes. 1 2 3 4 5
8 I recognize when I need support from my friends or family. 1 2 3 4 5
9 I have coping skills I can use in uncomfortable situations. 1 2 3 4 5
10 I have realistic expectations. 1 2 3 4 5

3. Nutrition Component
1 I take time to plan healthy meals. 1 2 3 4 5
2 I often find ways to reduce saturated fat from my diet. 1 2 3 4 5
3 I don’t eat processed foods i.e. takeaways, packet foods. 1 2 3 4 5
4 I’m aware that a diet high in sodium is not good for me. 1 2 3 4 5
5 I don’t eat food that is high in sugar. 1 2 3 4 5
6 I eat vegetables that are different colours. 1 2 3 4 5
7 I avoid pink meat i.e. sausages, salami, mince. 1 2 3 4 5
8 I drink plenty of water during the day. 1 2 3 4 5
9 Over the years, I never stop and start a healthy eating routine. 1 2 3 4 5
10 I can focus on eating healthy food and avoid unhealthy food. 1 2 3 4 5
Lifestyle Component
1 I am a non-smoker. 1 2 3 4 5
2 I drink alcohol in moderation or not at all. 1 2 3 4 5
3 I take time out during the week to relax. 1 2 3 4 5
4 I can control my stress when under pressure. 1 2 3 4 5
5 I watch TV less than 7 hours per week. 1 2 3 4 5
6 I look for healthy options when I eat out i.e. café’s. 1 2 3 4 5
7 I live my life with positive thoughts. 1 2 3 4 5
8 I enjoy being part of a group. 1 2 3 4 5
9 I am active during the day i.e. housework, physical job. 1 2 3 4 5
10 I spend as much time as I can with family and friends. 1 2 3 4 5
Stress Component
1 I can sleep undisturbed for 8 hours each night. 1 2 3 4 5
2 I have activities I like doing when it’s time for me to relax. 1 2 3 4 5
3 The environment around me is peaceful i.e. work, home. 1 2 3 4 5
4 I hardly ever have conflict with others. 1 2 3 4 5
5 I never worry. 1 2 3 4 5
6 I do not feel depressed or generally get unhappy. 1 2 3 4 5
7 I rest when my body is under a lot of stress. 1 2 3 4 5
8 My appetite doesn’t increase or decrease when stressed. 1 2 3 4 5
9 I never use alcohol, cigarettes or drugs to relax. 1 2 3 4 5
10 I hardly ever get sick. 1 2 3 4 5

4. To determine your current health, fitness and wellness situation take your
scores from the previous pages and plot them on the wheel below, starting
from the Mindset Component (M) and finishing with the Stress Component
(S). Then connect the dots. Dots plotted close to the centre are considered a
deviation and may answer why you have trouble improving your health,
fitness and wellness. The closer you get to a 10 for each component will
increase your chance of a successful outcome in regards to your health,
fitness and wellness.
Key:
Score of 5 = 1 notch. Score of 6 to 10 = 2 notches. Score of 11 to 15 = 3
notches. Score of 16 to 20 notches = 4 notches. Score of 21 to 25 = 5
notches. Score of 31 to 35 = 7 notches. Score of 36 to 40 = 8 notches. Score
of 41 to 45 = 9 notches. Score of 46 to 50 = 10 notches.
M
S 10 R
10 10
L 10 0 10 I
10
10
B
N
10
E