Consequences and owned repair record
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Optional blank sheet. Use only where appropriate for your privacy and circumstances. Do not add identifying or sensitive details unnecessarily. This is not therapy, legal advice, a safety assessment or a crisis service.

The actual stated limit or formal requirement:
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____________________________________________________________________

What is a personal participation choice:
____________________________________________________________________
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What needs the relevant formal process:
____________________________________________________________________
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The permitted channel, if any:
____________________________________________________________________
____________________________________________________________________

Practical repair I can legitimately complete:
____________________________________________________________________
____________________________________________________________________

What needs acceptance or authorization:
____________________________________________________________________
____________________________________________________________________

The behavior pattern I will replace:
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____________________________________________________________________

How I will check my own follow-through:
____________________________________________________________________
____________________________________________________________________

Support I will use without contacting the harmed person:
____________________________________________________________________
____________________________________________________________________

A demand that needs safety support or appropriate advice:
____________________________________________________________________
____________________________________________________________________

Original educational worksheet — RelateWell Guide
Article: https://relatewellguide.com/articles/apology-forgiveness-accept-consequences-after-harm/
Editorial revision: 2026-11-04