Template library · Assessments & screeners
Sleep Hygiene Assessment template
Review current sleep-related habits and environment.
Behavioral sleep habits checklist
- 18 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
Habits Reviewed
- Consistent sleep / wake scheduleTick box
- Screen use within 1 hour of bedtimeTick box
- Caffeine after middayTick box
- Alcohol use before bedTick box
- Regular exerciseTick box
- Naps longer than 30 minutesTick box
- Bedroom is dark, quiet, and coolTick box
- Bed used for activities other than sleepTick box
Notes & Recommendations
- Client-reported barriers to good sleepText
- Recommended changes to sleep environment or routineText
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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