Template library · Assessments & screeners
Burnout Recovery Check-In template
Track recovery progress and adjust recommendations.
Follow-up check-in for clients addressing burnout
- 14 fields across 4 sections
- Included with MyWellOps
- Edit it, or save your own version
What’s in it
Assessment Details
- Client NameText
- Date of BirthDate
- Client ID / MRNText
- Date of AssessmentDate
- Clinician / CoachText
- Location / ModalityText
Since Last Check-In
- 1. Energy levels at workChoice
- 2. Sense of engagement with tasksChoice
- 3. Ability to disconnect after work hoursChoice
Plan
- Changes implemented since last check-inText
- Barriers encounteredText
- Next stepsText
Signatures
- Clinician SignatureSignature
- Date signed (clinician)Date
When to use it
Use an assessment at the start of work to set a baseline, then repeat it at review points so you and the client can see what has changed.
How it works in MyWellOps
- Pick it from Documents.
- Send it to the client to complete, or fill it in together during a session.
- Each completed copy is kept on the client’s record, so earlier results are there to compare.
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