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2026 Wellness Management Tracking Form
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Begin: 3/2/26 End: 4/27/26
MONTUEWEDTHUFRISATSUNTOTALS
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Weight Loss
Beginning WeightEnding Weight
5
000
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Week 1:
7
Sleep7+ hours sleep 0
8
NutritionVeggies 3-4 cups 0
9
Fruit 4-5 cups0
10
Grain 3-6 ounces0
11
Dairy or Dairy substitute 3 cups0
12
Protein 56g male, 46g female 0
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Mental20 minutes mental health 0
14
Exercise 30 minutes moderate exercise0
15
Week 2:
16
Sleep7+ hours sleep 0
17
NutritionVeggies 3-4 cups 0
18
Fruit 4-5 cups0
19
Grain 3-6 ounces0
20
Dairy or Dairy substitute 3 cups0
21
Protein 56g male, 46g female 0
22
Mental20 minutes mental health 0
23
Exercise 30 minutes moderate exercise0
24
Week 3:
25
Sleep7+ hours sleep 0
26
NutritionVeggies 3-4 cups 0
27
Fruit 4-5 cups0
28
Grain 3-6 ounces0
29
Dairy or Dairy substitute 3 cups0
30
Protein 56g male, 46g female 0
31
Mental20 minutes mental health 0
32
Exercise 30 minutes moderate exercise0
33
Week 4:
34
Sleep7+ hours sleep 0
35
NutritionVeggies 3-4 cups 0
36
Fruit 4-5 cups0
37
Grain 3-6 ounces0
38
Dairy or Dairy substitute 3 cups0
39
Protein 56g male, 46g female 0
40
Mental20 minutes mental health 0
41
Exercise 30 minutes moderate exercise0
42
Week 5:
43
Sleep7+ hours sleep 0
44
NutritionVeggies 3-4 cups 0
45
Fruit 4-5 cups0
46
Grain 3-6 ounces0
47
Dairy or Dairy substitute 3 cups0
48
Protein 56g male, 46g female 0
49
Mental20 minutes mental health 0
50
Exercise 30 minutes moderate exercise0
51
Week 6:
52
Sleep7+ hours sleep 0
53
NutritionVeggies 3-4 cups 0
54
Fruit 4-5 cups0
55
Grain 3-6 ounces0
56
Dairy or Dairy substitute 3 cups0
57
Protein 56g male, 46g female 0
58
Mental20 minutes mental health 0
59
Exercise 30 minutes moderate exercise0
60
Week 7:
61
Sleep7+ hours sleep 0
62
NutritionVeggies 3-4 cups 0
63
Fruit 4-5 cups0
64
Grain 3-6 ounces0
65
Dairy or Dairy substitute 3 cups0
66
Protein 56g male, 46g female 0
67
Mental20 minutes mental health 0
68
Exercise 30 minutes moderate exercise0
69
Week 8:
70
Sleep7+ hours sleep 0
71
NutritionVeggies 3-4 cups 0
72
Fruit 4-5 cups0
73
Grain 3-6 ounces0
74
Dairy or Dairy substitute 3 cups0
75
Protein 56g male, 46g female 0
76
Mental20 minutes mental health 0
77
Exercise 30 minutes moderate exercise0
78
79
Total SleepNutritionGrand Total0
80
Employee Name:_________________________
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Employee Id:____________________________
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School:________________________________
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90
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96
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100