One action, one replacement behavior
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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 action causing harm:
____________________________________________________________________
____________________________________________________________________

The practical consequence still to address:
____________________________________________________________________
____________________________________________________________________

The moment immediately before the action:
____________________________________________________________________
____________________________________________________________________

The specific replacement I can choose:
____________________________________________________________________
____________________________________________________________________

The planning, reminder or support step I will maintain:
____________________________________________________________________
____________________________________________________________________

Any appropriate practical repair that is accepted:
____________________________________________________________________
____________________________________________________________________

How I will address a lapse honestly:
____________________________________________________________________
____________________________________________________________________

Relevant care, work or formal procedures to follow:
____________________________________________________________________
____________________________________________________________________

A contact limit I need to respect:
____________________________________________________________________
____________________________________________________________________

What I can review without requiring the recipient to supervise:
____________________________________________________________________
____________________________________________________________________

Original educational worksheet — RelateWell Guide
Article: https://relatewellguide.com/articles/apology-forgiveness-know-when-an-apology-needs-changed-behavior/
Editorial revision: 2026-11-04