NAME: ________________________________________________________ PE SCHEDULE: ____________

PROGRAM, YEAR & SECTION: ___________________________________

PERSONAL FOOD LOG
DAY / DATE:

MEAL & LEVEL FOOD & BEVERAGES FOOD

PLACE THOUGHTS/FEELINGS AMOUNT
TIME HUNGER FULLNESS (AND HOW PREPARED) (PHOTO/EVIDENCE)
Breakfast / Home(kitchen, at table, in front of TV) Hungry, in a hurry Egg, poached orange 1
8:15AM (EXAMPLE) (EXAMPLE) Juice ½ cup
(EXAMPLE) Toast of bread 1 slice
Margarine 1 tsp
(EXAMPLE) (EXAMPLE)
AM Snacks

Lunch

PM Snacks

Dinner

MN Snacks
NAME: ________________________________________________________ PE SCHEDULE: ____________
PROGRAM YEAR & SECTION: ___________________________________
PERSONAL FOOD LOG

DAY / DATE:

MEAL & PLACE THOUGHTS/FEELINGS LEVEL FOOD & BEVERAGES AMOUNT FOOD
TIME HUNGER FULLNESS (AND HOW PREPARED) (PHOTO/EVIDENCE)
Breakfast

AM Snacks

Lunch

PM Snacks

Dinner

MN Snacks