1. Name the worry in one sentence
2. Is safe, concrete action available now?
☐ Yes ☐ No ☐ I need qualified advice
3. If yes, what is the smallest next action?
4. If no immediate action is needed, choose a review time
Date: ____________________ Time: ______________
5. At review
☐ Actionable ☐ Changed ☐ Resolved ☐ Still uncertain