1. Recent Reality (Itch / Struggle Scan)
When did you last notice something like this? (check any that apply)
- ☐ After a call or interaction, it stuck with you longer than you wanted
- ☐ Hard to shift focus between tasks or calls
- ☐ Mind got pulled off target (distraction, overfocus, or missed detail)
- ☐ Breathing tightened or you felt physically keyed up
- ☐ Carried work stress into home or off-shift time
- ☐ Energy dipped or attention faded mid-shift
- ☐ Knew what to do, just didn’t do it in the moment
2. What Actually Happened
Pick one situation above.
Briefly: what was going on?
3. What Did You Draw From
In that moment, what did you actually do?
- ☐ Nothing / pushed through
- ☐ Tried to refocus mentally
- ☐ Used breathing or physical reset
- ☐ Shifted attention to task or environment
- ☐ Talked it out / decompressed later
- ☐ Something else: ______________________________________________
4. What Pulled Your Attention
Looking back:
What seemed to grab your attention most?
- ☐ Something familiar (pattern, past experience, expectation)
- ☐ Something that stood out (urgent, emotional, distracting)
- ☐ The task you were trying to complete
- ☐ Not sure
5. What Would Have Helped (light forward bridge)
In that moment, would it have helped to have:
- ☐ Something quick to reset (30–90 seconds)
- ☐ A clearer way to refocus on the task
- ☐ A way to drop what you were carrying
- ☐ Nothing needed / handled fine
6. Interest (no pressure, no pitch)
Would you have interest in having a few simple options you can draw from in those moments?
- ☐ Yes — something quick and practical
- ☐ Maybe — depends on what it is
- ☐ Not really
7. Optional (if yes / maybe)
If you were to try something, what would matter most?
- ☐ Fast and simple
- ☐ Works in the middle of a shift
- ☐ No tracking / no extra work
- ☐ Something I can come back to when needed
Why This Matters
Your attention doesn’t just go where you want.
It gets pulled:
- by what you’ve seen before
- by what stands out
- by what feels urgent
Sometimes that’s useful.
Sometimes it keeps you stuck longer than needed.
The goal isn’t to control everything.
It’s to notice what’s still active—and reset just enough to move on clean.