QUIT TOOLS - Quit Smoking Worksheet

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QUIT PLAN

Use this tool to help you plan for quitting. Go through the worksheet and add: your triggers, those hooks that remind you to smoke; your strategies, skills to help you stay smoke-free; your support, someone who really cares about you and wants you to stop smoking; your rewards, meaningful incentives to help you through your quit process. Once completed, print it out and carry it with you to remind you that you are quitting smoking!!

I plan to quit smoking:

My most common triggers are:

Driving a Car
Other kids smoking
Stress
School
Boredom
Hunger
Anger
Other Drugs
Being Alone
After waking up
After eating

I will use these coping strategies to control my urges to smoke :

Deep breathing
Chew gum or sugarless candy
Drink water
Call a friend
Exercise
Hang out with friends who don't smoke
Keep busy
Listen to music
Play video games
Think about why you are quitting
Watch TV
Meditate
Draw
Change your routine
Delay for a few minutes

My number one coping strategy is .

My support person is .

If you choose "Other" as the support person, please fill in the blank and be specific:

He or she will help me by .

My reward for quitting smoking for one day is .

My reward for quitting smoking for one week is .

My reward for quitting smoking for one month is .

My reward for quitting smoking for three months is .

My reward for quitting smoking for one year is .