1. Number of sexual fantasies:
Describe date, time, place, content, persons involved, sex and ages.
(Define fantasies to include dreams, thoughts, objectifying, flashes, etc.)

2. Number of times masturbated: 
Describe time, place, method of stimulation, fantasy and situation.

3. Any aggressive fantasies even if interrupted?  YES  NO
(Fantasies involving physical harm to self, others, animals or property) 

4. Any deviant sexual fantasies? YES  NO
(Involving force, tricks, games, money animals, pain, someone under the age of 18, exhibitionism, voyeurism, frottage, urine, feces, cross-dressing, incest, sexual behavior or masturbation with non-living objects, obscene phone calls, bondage, fire, use of weapons, secrecy, threats)

5. Any contact with your victim(s)? YES  NO

6. Placed self in any risk situations?  YES  NO
(Being in or around places or situations where: A) Your victim(s) or people like your victim(s) spend time without supervision by someone who knows your sexually abusive history. B) Drugs or alcohol are available or consumed. C) Objects or people that have been part of your deviant sexual behavior in the past)

7. Spent time with people you did not have permission from P.O., therapist, and/or group to see?  YES  NO

8. Broken any rules set by the court, P.O., therapist and/or group?  YES  NO

9. Broken any laws?  YES  NO

10. Been with anyone while they have broken a law?  YES  NO
(Include friends, co-workers, others)

11. Used any drugs or alcohol, prescription or non-prescription? YES  NO

12. Any contact with pornography or utilization of non-pornographic materials
to stimulate sexual arousal or fantasy?  YES  NO
(Include newspapers, catalogs, magazine, videos, TV, audio tapes, video tapes, nude pictures or books)

13. Have you reviewed your tape from the last group
 you attended in full? YES NO

14. Any arguments with family members?  YES  NO
If yes, describe how you resolved them.

15. Missed appointments with therapists or P.O.?  YES  NO

16. Challenged authority? YES  NO
(Defined as argued with, disobeyed, lied to or failed to follow through with commitments or as disagreeing with actions or decisions which you felt were inappropriate.)

17. Done any thing to build respect in friendships? YES  NO
(Defined as being helpful or especially caring)

18. Worked on clarification?  YES  NO

19. Were you in cycle?  YES  NO
If yes, how did you get out?

20. Are you in cycle now?  YES  NO

21. Explain what thinking errors you have used, how you have used them, what alternatives you had to not use them and how you have gone back to these situations and used the alternatives.  A minimum of 5 answers are expected.

22. Had successes or positive experiences?  YES  NO

23. Had any bad experiences or failures?  YES  NO

24. Have you engaged in:

A. Homosexual behavior?  YES  NO
B. Heterosexual behavior?  YES  NO
C. Exhibitionism (flashing)? YES  NO
D. Obscene phone calls or calling phone sex numbers? YES  NO
E. Voyeurism (peeping)?  YES  NO
F. Frottage (rubbing against, grabbing genital, breast, and/or buttocks areas of another person)?  YES  NO
G. Bestiality (sexual contact with animals)?  YES  NO
H. Abusing, hitting, torturing or killing animals?  YES  NO
I. Setting fires for enjoyment or arousal?  YES  NO
J. Incest (sexual contact with a relative)?  YES  NO
K. Rape (forcing another person into sexual behavior either verbally or physically)?  YES  NO
L. Prostitution (giving or receiving sex in exchange for favors, goods, or money)?  YES  NO
M. Taking indecent liberties (abusing others verbally or acting in ways to purposely frustrate, hurt the feelings of or make others uncomfortable)?  YES  NO
N. Bondage (use of ropes, chains, etc. to restrain movement of self or others during sexual interactions)?  YES  NO
O. Use of sexual aids or toys?  YES NO
P. Cross-dressing (Wearing clothes of the opposite sex)?  YES  NO
Q. Fetish behavior (Use of non-living objects or non-sexual body parts as source of sexual stimulation)?  YES  NO
R. Sex with dead animals or people?  YES  NO
S. Use of urine or feces during sexual activities or as a source of sexual stimulation?  YES  NO
T. Sexual contact with anyone under the age of 18 (sexual activity or touching the genitals, breasts or buttocks either inside or outside of the clothing)?  
YES  NO
U. Use of any weapons for sexual or non-sexual reasons (knives, guns, throwing sears, num-chucks, brass-knuckles, razor blades, etc.)?  YES  NO

25. Had any fights?
A. Physical  YES  NO
B. Verbal  YES  NO

26. What homework did you complete?


27. What homework didn't you complete?


28. What do you want or need to discuss in group?


29. Describe social activities you have been involved in.


30. Did you complete your log on a daily bases this week?  YES  NO

31. Have you been financially responsible this week (paid your bills including your therapy fees)?  YES  NO

32. Have you shared this check-in sheet with your wife or partner after completing it this week?  YES  NO

33. What is your current goal to complete in therapy?


34. What is most confusing in your life right now?


35. What has your greatest frustration been in the past week?


36. When did you complete this check-in sheet:
and how much time did you spend on it:

37. Have you answered all the questions on this sheet truthfully?  YES  NO