Emotional Check-In Tool: Name a Feeling and Keep the Next Choice Yours

ONE MOMENT, IF USEFUL:
FEELING WORD / MIXED / UNSURE / NONE:
SITUATION FACT:
INTERPRETATION, IF ANY, LABELLED SEPARATELY:
OPTIONAL BODY NOTE:
MY NEXT CHOICE / NO CHOICE NEEDED:
KEEP A COPY / CLEAR / SAVE NOTHING:

Original optional record; not an assessment or a required practice.