Healthy Lifestyle Log - Week 1
Please complete this weekly log to track your physical, mental, and social health for the week.
Sign in to Google
to save your progress.
How Many Days Did You Consume over 2,000 Daily Calories last week
How many days did you consume (Fast or Restaurant Food)
1 to 3
4 to 5
More than 10
What Snacks did you consume
Chips (ex.Hot Fries, Grippos etc)
Pastries (ex.Cookies, Honey Buns, Donuts, Cake)
Candy (ex Skittles, Candy Bars, Blow Pops, Fruities)
Fruit (ex.Bananas, Strawberries, Apples, Oranges, etc.)
Did you drink more water than soft drinks or juice
How many Stress-Free days did you have last week?
What kind of positive activity did you do to relieve stress during the week
Physical Fitness (ex. Sports,. Weight Training)
Leisure Activites (ex.Book Reading, Walking, Food, Cooking, Horse Play)
Recreational Activites (ex. Biking, Skating, Fishing, Hiking)
Technology Activties (ex. Cell Phone, Video Games)
Family and Friends Activites
List something positive you did or happen last week
Provide a link to an article or video related to physical, mental, social, or emotional health.
Never submit passwords through Google Forms.
This form was created inside of Jefferson County Public Schools.