Page 4 - Staff 5C Check & Review
P. 4

The Simple 5C Needs Plan & Review




      How well are my 5C Needs met?                      Things that would help to meet my need better       Review: Did it work? What now?


                  Feeling comfortable




       0  1                       3  4  5  6  7  8  9  10
               2
      I do not feel comfortable      I feel really comfortable

                    Feeling connected





       0  1                      3  4  5  6  7  8  9  10
               2
       I do not feel connected         I feel really connected

                     Feeling I count




               2
       0  1                       3  4  5  6  7  8  9  10
       I do not feel I count             I feel I really count

                     Feeling capable




          1                      3  4  5  6  7  8  9  10
               2
       I do not feel capable            I feel really capable

                Feeling a sense of control




       0  1                      3  4  5  6  7  8  9  10
               2
       I do not feel a sense of control  I feel a strong sense of control
   1   2   3   4   5   6   7