A body-awareness worksheet records contact, movement, and internal sensations separately. It invites observation without a score and without insisting that more inward attention is better.
Work through these questions: Chair supports my back
Completed fictional example — SAMPLE DATA
This example shows how to fill in the form. It is not a real person’s record, a diagnosis, a validated assessment or a promised outcome. Use your own observations and appropriate professional advice for actual health concerns.
| Question or field | Your entry |
|---|---|
| Contact? | Chair contact under the legs |
| Movement? | Hands moving to close the notebook |
| Internal sensation? | An ordinary sense of thirst |
| Interpretation? | Cause not established by this worksheet |
| Next ordinary need? | Take an appropriate ordinary break and return to the activity |
Blank worksheet — copy or print
Copy the form into your own private document or print this page. Replace each “Your entry” cell with your own note; leave anything uncertain clearly marked as unknown. This page does not save or submit your entries.
| Question or field | Your entry |
|---|---|
| Contact? | Your entry |
| Movement? | Your entry |
| Internal sensation? | Your entry |
| Interpretation? | Your entry |
| Next ordinary need? | Your entry |
Completed example
| Question or field | Fictional completed example |
|---|---|
| Contact? | Chair supports my back |
| Movement? | I changed position |
| Internal sensation? | Unsure |
| Interpretation? | No conclusion |
| Next ordinary need? | Return to the task |
A worked situation: Chair supports my back
Fictional example. A reader notices chair contact clearly but is unsure how to describe abdominal sensations. Uncertain is an acceptable entry; she does not continue scanning until she can produce a confident answer.