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Daily Record of Activity

A - Activity Categories
B - Daily Record of Activity
C - Weekly Record of Activity
D - Daily Routine Planner
E - Weekly Routine Planner
F - Symptom Score Chart
G - Daily Diary Grid
H - Symptom Categories & Warning Signs

B. Daily Record of Activity

Use this form to record your current daily activity, in detail - what you are doing, how long you do it for and whether it is High, Medium or Low energy use?  Build up a picture of how you currently spend your time and energy.  Do you have the right balance of rest and activity?  (If your activity doesn't vary much from day to day you may wish to use the Weekly Record of Activity Form instead.)


Completing the Daily Record of Activity will show you the strengths and weaknesses of your current lifestyle. Do you have the right balance of rest and activity? Using this information will help you when considering an improved and more balanced routine, to be entered on the Daily or Weekly Routine Planner.   


There is one completed example and one blank template of this form.  Blank forms are available in Word or PDF format.  Example forms are available in PDF format only.   Click on the DOWNLOAD buttons below.

Daily record of activity - example

Daily Record of Activity EXAMPLE (pdf)

Download

Daily record of activity - blank

Daily Record of Activity BLANK (pdf)

Download

Daily Record of Activity BLANK (WORD) (docx)

Download

CLICK BELOW TO DOWNLOAD A PDF OF ALL THE FORMS AND TEXT - 32 pages (3.3 MB)

Total ME Forms Website (pdf)

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