Kindness Checklist

My Kind Acts for the Month of ……………….

This sheet allows you to keep track of the kind acts you carry out each day for a month. Score one mark for each square ticked, and total the scores at the end of the month. Photocopy this blank sheet to use for other months. By keeping a tally of your kind acts it will raise your awareness to kindness, and your score should increase over a period of time. There is a square for each day. The scoring only allows for one act of kindness per day in each category. Thank you for your participation, and may the Angel of Kindness always be at your side.

Kindness to Yourself Total
Today I made time to meditate, listen to relaxing music, or set aside other quiet time for myself
o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o
Today I had a massage, a facial, a scented bath, or pampered myself in some other way
o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o
Today I took a long look at the sky, or a tree, a bird, an ant, or some other, wonderful, natural thing
o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o
Today I thought about my uniqueness, my youthful attitude toward life, and how worthy and lovable I am
o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o
Today I . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o



Kindness to Others
Today I smiled/said hello/nodded/waved to someone
o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o
Today I listened attentively when someone was talking to me
o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o
Today I supported someone by cheering them up, listening to their problem, etc
o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o
Today I told someone how much they mean to me
o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o
Today I phoned or sent a card/letter to someone I haven't been in contact with lately
o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o
Today I complimented someone about their smile, their attitude, something they'd done well, etc
o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o
Today I thanked everyone who did something for me, no matter how small it was
o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o
Today I refrained from negative judgements and gossiping
o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o
Today I chose to be more positive with my thoughts and words
o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o
Today I . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o
Today I . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o



Kindness to the Earth
Today I left the car at home and used public transport/restricted my use of water and/or electricity, etc
o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o
Today I picked up litter, recycled goods, or helped the environment in some way
o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o
Today I . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o
_______
Total score for the month

Tick your squares at the end of each day. The entries that are blank after "Today I" are there for you to write an act of kindness you can carry out regularly that isn't mentioned in the list. We also recommend you keep a journal of your acts of kindness, and the feelings you experienced in different situations during the day.

© 2003 The Australian Kindness Movement

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