Instructions on How to Use RM 7–PA: Physical Activity Log

1. In the column Activity indicate the physical activity or exercise that you participated in
(e.g., brisk walk to school, hockey practice).

2. In the column Primary Health-Related Fitness Component indicate the primary or most prevalent
health-related fitness component that the physical activity addresses. Use the following code: CRE–
cardiorespiratory endurance; MS–Muscular Strength; ME–Muscular Endurance; FL–Flexibility.

3. In the column Exercise Time you have a choice of three exercise intensities. Indicate the amount of
time (in minutes) spent at each level for the stated activity (e.g., total time is 40 minutes, with 10 minutes
at Light, 10 minutes at Moderate, and 20 minutes at Vigorous intensity level).
4. In the column Health Habit Satisfaction insert the number 1 in each row for Exercise, Diet, Stress,
and Sleep in the column that best represents your level of satisfaction with the health habit (High–very
satisfied; Medium–somewhat satisfied; Low–not satisfied).

5. The record for the day may include a daily health reflection. The number of records required will be
determined by your teacher. Your reflection may address
a. how you felt that day
b. your progress toward an active healthy lifestyle
c. how you were influenced to make healthy or unhealthy decisions
d. goals you revised or achieved, and so on
e. your thoughts related to any aspect of your personal healthy lifestyle

6. At the end of one week print your record and have it signed by your parent/guardian. The signature is a
certification that the information appearing on the record is true and accurate.

Note: The information that you provide on the Physical Activity Log is automatically tabulated and your
time is converted to an hourly record on a weekly, monthly, and cumulative basis. A periodic review of the
Course Summary sheet will let you know how you are progressing toward your goals.
 Name ___________________________
RM 7–PA: Physical Activity Log Grade _____

Week of _______________________ Student's Daily Physical Activity Log for the Month of _____________________________________
Primary Health- Exercise Time Health Habit Satisfaction Daily Reflection / Rating
Day Activity Related Fitness
Component Light Mod Vig Habit High Med Low
Exercise
Diet
Monday
Stress
Sleep Overall Rating: /5
Light Mod Vig Habit High Med Low
Exercise
Tuesday Diet
Stress
Sleep Overall Rating: /5
Light Mod Vig Habit High Med Low
Exercise
Wednesday Diet
Stress
Sleep Overall Rating: /5
Light Mod Vig Habit High Med Low
Exercise
Thursday Diet
Stress
Sleep Overall Rating: /5
Light Mod Vig Habit High Med Low
Exercise
Friday Diet
Stress
Sleep Overall Rating: /5
Light Mod Vig Habit High Med Low
Exercise
Saturday Diet
Stress
Sleep Overall Rating: /5
Light Mod Vig Habit High Med Low
Exercise
Sunday Diet
Stress
Sleep Overall Rating: /5
0 0 0 Total 0 0 0
Parent/Guardian Signature: Total Hours for the Week 1 0.0 0.0 Total Hours of Moderate to Vigorous Activity for the Week
 Name ___________________________
RM 7–PA: Physical Activity Log Grade _____

Student Signature: ______________________________________ I hereby certify that this record is an accurate account of my physical activity participation.

Week of _______________________ Student's Daily Physical Activity Log for the Month of _____________________________________
Primary Health- Exercise Time Health Habit Satisfaction Daily Reflection / Rating
Day Activity Related Fitness
Component Light Mod Vig Habit High Med Low
Exercise
Diet
Monday
Stress
Sleep Overall Rating: /5
Light Mod Vig Habit High Med Low
Exercise
Tuesday Diet
Stress
Sleep Overall Rating: /5
Light Mod Vig Habit High Med Low
Exercise
Wednesday Diet
Stress
Sleep Overall Rating: /5
Light Mod Vig Habit High Med Low
Exercise
Thursday Diet
Stress
Sleep Overall Rating: /5
Light Mod Vig Habit High Med Low
Exercise
Friday Diet
Stress
Sleep Overall Rating: /5
Light Mod Vig Habit High Med Low
Exercise
Saturday Diet
Stress
Sleep Overall Rating: /5
Light Mod Vig Habit High Med Low
Exercise
Sunday Diet
Stress
Sleep Overall Rating: /5
0 0 0 Total 0 0 0
Parent/Guardian Signature:
 Name ___________________________
RM 7–PA: Physical Activity Log Grade _____

Parent/Guardian Signature: Total Hours for the Week 2 0.0 0.0 Total Hours of Moderate to Vigorous Activity for the Week

Student Signature: ______________________________________ I hereby certify that this record is an accurate account of my physical activity participation.

Week of _______________________ Student's Daily Physical Activity Log for the Month of _____________________________________
Primary Health- Exercise Time Health Habit Satisfaction Daily Reflection / Rating
Day Activity Related Fitness
Component Light Mod Vig Habit High Med Low
Exercise
Diet
Monday
Stress
Sleep Overall Rating: /5
Light Mod Vig Habit High Med Low
Exercise
Tuesday Diet
Stress
Sleep Overall Rating: /5
Light Mod Vig Habit High Med Low
Exercise
Wednesday Diet
Stress
Sleep Overall Rating: /5
Light Mod Vig Habit High Med Low
Exercise
Thursday Diet
Stress
Sleep Overall Rating: /5
Light Mod Vig Habit High Med Low
Exercise
Friday Diet
Stress
Sleep Overall Rating: /5
Light Mod Vig Habit High Med Low
Exercise
Saturday Diet
Stress
Sleep Overall Rating: /5
Light Mod Vig Habit High Med Low
Exercise
Sunday Diet
Stress
Sleep Overall Rating: /5
 Name ___________________________
RM 7–PA: Physical Activity Log Grade _____

0 0 0 Total 0 0 0
Parent/Guardian Signature: Total Hours for the Week 3 0.0 0.0 Total Hours of Moderate to Vigorous Activity for the Week

Student Signature: ______________________________________ I hereby certify that this record is an accurate account of my physical activity participation.

Week of _______________________ Student's Daily Physical Activity Log for the Month of _____________________________________
Primary Health- Exercise
Health Habit Satisfaction Daily Reflection / Rating
Day Activity Related Fitness Intensity
Component Light Mod Vig Habit High Med Low
Exercise
Diet
Monday
Stress
Sleep Overall Rating: /5
Light Mod Vig Habit High Med Low
Exercise
Tuesday Diet
Stress
Sleep Overall Rating: /5
Light Mod Vig Habit High Med Low
Exercise
Wednesday Diet
Stress
Sleep Overall Rating: /5
Light Mod Vig Habit High Med Low
Exercise
Thursday Diet
Stress
Sleep Overall Rating: /5
Light Mod Vig Habit High Med Low
Exercise
Friday Diet
Stress
Sleep Overall Rating: /5
Light Mod Vig Habit High Med Low
Exercise
Saturday Diet
Stress
Sleep Overall Rating: /5
Light Mod Vig Habit High Med Low
Exercise
Sunday Diet
Stress
 Name ___________________________
Sunday
RM 7–PA: Physical Activity Log Grade _____

Sleep Overall Rating: /5

0 0 0 Total 0 0 0
Total Hours for the Week 4 0.0 0.0 Total Hours of Moderate to Vigorous Activity for the Week
Parent/Guardian Signature: 0.0 Total Hours for the Month of 0.0 Total Hours of Moderate to Vigorous Activity for the Month

Student Signature: ______________________________________ I hereby certify that this record is an accurate account of my physical activity participation.
Exercise 0 0 0
Diet 0 0 0
Stress 0 0 0
Sleep 0 0 0
 RM 7–PA: Physical Activity Log
Name ______________________ Grade ____

Week of _______________________ Student's Daily Physical Activity Log for the Month of _____________________________________
Primary Health- Exercise Time Health Habit Satisfaction Daily Reflection / Rating
Day Activity Related Fitness
Component Light Mod Vig Habit High Med Low
Exercise
Diet
Monday
Stress
Sleep Overall Rating: /5
Light Mod Vig Habit High Med Low
Exercise
Tuesday Diet
Stress
Sleep Overall Rating: /5
Light Mod Vig Habit High Med Low
Exercise
Wednesday Diet
Stress
Sleep Overall Rating: /5
Light Mod Vig Habit High Med Low
Exercise
Thursday Diet
Stress
Sleep Overall Rating: /5
Light Mod Vig Habit High Med Low
Exercise
Friday Diet
Stress
Sleep Overall Rating: /5
Light Mod Vig Habit High Med Low
Exercise
Saturday Diet
Stress
Sleep Overall Rating: /5
Light Mod Vig Habit High Med Low
Exercise
Sunday Diet
Stress
Sleep Overall Rating: /5
0 0 0 Total 0 0 0
Parent/Guardian Signature: Total Hours for the Week 1 0.0 0.0 Total Hours of Moderate to Vigorous Activity for the Week
 RM 7–PA: Physical Activity Log
Name ______________________ Grade ____

Student Signature: ______________________________________ I hereby certify that this record is an accurate account of my physical activity participation.

Week of _______________________ Student's Daily Physical Activity Log for the Month of _____________________________________
Primary Health- Exercise Time Health Habit Satisfaction Daily Reflection / Rating
Day Activity Related Fitness
Component Light Mod Vig Habit High Med Low
Exercise
Diet
Monday
Stress
Sleep Overall Rating: /5
Light Mod Vig Habit High Med Low
Exercise
Tuesday Diet
Stress
Sleep Overall Rating: /5
Light Mod Vig Habit High Med Low
Exercise
Wednesday Diet
Stress
Sleep Overall Rating: /5
Light Mod Vig Habit High Med Low
Exercise
Thursday Diet
Stress
Sleep Overall Rating: /5
Light Mod Vig Habit High Med Low
Exercise
Friday Diet
Stress
Sleep Overall Rating: /5
Light Mod Vig Habit High Med Low
Exercise
Saturday Diet
Stress
Sleep Overall Rating: /5
Light Mod Vig Habit High Med Low
Exercise
Sunday Diet
Stress
Sleep Overall Rating: /5
0 0 0 Total 0 0 0
Parent/Guardian Signature:
 RM 7–PA: Physical Activity Log
Name ______________________ Grade ____
Parent/Guardian Signature: Total Hours for the Week 2 0.0 0.0 Total Hours of Moderate to Vigorous Activity for the Week

Student Signature: ______________________________________ I hereby certify that this record is an accurate account of my physical activity participation.

Week of _______________________ Student's Daily Physical Activity Log for the Month of _____________________________________
Primary Health- Exercise Time Health Habit Satisfaction Daily Reflection / Rating
Day Activity Related Fitness
Component Light Mod Vig Habit High Med Low
Exercise
Diet
Monday
Stress
Sleep Overall Rating: /5
Light Mod Vig Habit High Med Low
Exercise
Tuesday Diet
Stress
Sleep Overall Rating: /5
Light Mod Vig Habit High Med Low
Exercise
Wednesday Diet
Stress
Sleep Overall Rating: /5
Light Mod Vig Habit High Med Low
Exercise
Thursday Diet
Stress
Sleep Overall Rating: /5
Light Mod Vig Habit High Med Low
Exercise
Friday Diet
Stress
Sleep Overall Rating: /5
Light Mod Vig Habit High Med Low
Exercise
Saturday Diet
Stress
Sleep Overall Rating: /5
Light Mod Vig Habit High Med Low
Exercise
Sunday Diet
Stress
Sleep Overall Rating: /5
 RM 7–PA: Physical Activity Log
Name ______________________ Grade ____
0 0 0 Total 0 0 0
Parent/Guardian Signature: Total Hours for the Week 3 0.0 0.0 Total Hours of Moderate to Vigorous Activity for the Week

Student Signature: ______________________________________ I hereby certify that this record is an accurate account of my physical activity participation.

Week of _______________________ Student's Daily Physical Activity Log for the Month of _____________________________________
Primary Health- Exercise
Health Habit Satisfaction Daily Reflection / Rating
Day Activity Related Fitness Intensity
Component Light Mod Vig Habit High Med Low
Exercise
Diet
Monday
Stress
Sleep Overall Rating: /5
Light Mod Vig Habit High Med Low
Exercise
Tuesday Diet
Stress
Sleep Overall Rating: /5
Light Mod Vig Habit High Med Low
Exercise
Wednesday Diet
Stress
Sleep Overall Rating: /5
Light Mod Vig Habit High Med Low
Exercise
Thursday Diet
Stress
Sleep Overall Rating: /5
Light Mod Vig Habit High Med Low
Exercise
Friday Diet
Stress
Sleep Overall Rating: /5
Light Mod Vig Habit High Med Low
Exercise
Saturday Diet
Stress
Sleep Overall Rating: /5
Light Mod Vig Habit High Med Low
Exercise
Sunday Diet
Stress
Sunday RM 7–PA: Physical Activity Log
Name ______________________ Grade ____
Sleep Overall Rating: /5
0 0 0 Total 0 0 0
Total Hours for the Week 4 0.0 0.0 Total Hours of Moderate to Vigorous Activity for the Week
Parent/Guardian Signature: 0.0 Total Hours for the Month of 0.0 Total Hours of Moderate to Vigorous Activity for the Month

Student Signature: ______________________________________ I hereby certify that this record is an accurate account of my physical activity participation.
Exercise 0 0 0
Diet 0 0 0
Stress 0 0 0
Sleep 0 0 0
 RM 7–PA: Physical Activity Log
Name ________________ Grade ___

Week of _______________________ Student's Daily Physical Activity Log for the Month of _____________________________________
Primary Health- Exercise Time Health Habit Satisfaction Daily Reflection / Rating
Day Activity Related Fitness
Component Light Mod Vig Habit High Med Low
Exercise
Diet
Monday
Stress
Sleep Overall Rating: /5
Light Mod Vig Habit High Med Low
Exercise
Tuesday Diet
Stress
Sleep Overall Rating: /5
Light Mod Vig Habit High Med Low
Exercise
Wednesday Diet
Stress
Sleep Overall Rating: /5
Light Mod Vig Habit High Med Low
Exercise
Thursday Diet
Stress
Sleep Overall Rating: /5
Light Mod Vig Habit High Med Low
Exercise
Friday Diet
Stress
Sleep Overall Rating: /5
Light Mod Vig Habit High Med Low
Exercise
Saturday Diet
Stress
Sleep Overall Rating: /5
Light Mod Vig Habit High Med Low
Exercise
Sunday Diet
Stress
Sleep Overall Rating: /5
0 0 0 Total 0 0 0
Parent/Guardian Signature: Total Hours for the Week 1 0.0 0.0 Total Hours of Moderate to Vigorous Activity for the Week
 RM 7–PA: Physical Activity Log
Name ________________ Grade ___

Student Signature: ______________________________________ I hereby certify that this record is an accurate account of my physical activity participation.

Week of _______________________ Student's Daily Physical Activity Log for the Month of _____________________________________
Primary Health- Exercise Time Health Habit Satisfaction Daily Reflection / Rating
Day Activity Related Fitness
Component Light Mod Vig Habit High Med Low
Exercise
Diet
Monday
Stress
Sleep Overall Rating: /5
Light Mod Vig Habit High Med Low
Exercise
Tuesday Diet
Stress
Sleep Overall Rating: /5
Light Mod Vig Habit High Med Low
Exercise
Wednesday Diet
Stress
Sleep Overall Rating: /5
Light Mod Vig Habit High Med Low
Exercise
Thursday Diet
Stress
Sleep Overall Rating: /5
Light Mod Vig Habit High Med Low
Exercise
Friday Diet
Stress
Sleep Overall Rating: /5
Light Mod Vig Habit High Med Low
Exercise
Saturday Diet
Stress
Sleep Overall Rating: /5
Light Mod Vig Habit High Med Low
Exercise
Sunday Diet
Stress
Sleep Overall Rating: /5
0 0 0 Total 0 0 0
Parent/Guardian Signature:
 RM 7–PA: Physical Activity Log
Name ________________ Grade ___
Parent/Guardian Signature: Total Hours for the Week 2 0.0 0.0 Total Hours of Moderate to Vigorous Activity for the Week

Student Signature: ______________________________________ I hereby certify that this record is an accurate account of my physical activity participation.

Week of _______________________ Student's Daily Physical Activity Log for the Month of _____________________________________
Primary Health- Exercise Time Health Habit Satisfaction Daily Reflection / Rating
Day Activity Related Fitness
Component Light Mod Vig Habit High Med Low
Exercise
Diet
Monday
Stress
Sleep Overall Rating: /5
Light Mod Vig Habit High Med Low
Exercise
Tuesday Diet
Stress
Sleep Overall Rating: /5
Light Mod Vig Habit High Med Low
Exercise
Wednesday Diet
Stress
Sleep Overall Rating: /5
Light Mod Vig Habit High Med Low
Exercise
Thursday Diet
Stress
Sleep Overall Rating: /5
Light Mod Vig Habit High Med Low
Exercise
Friday Diet
Stress
Sleep Overall Rating: /5
Light Mod Vig Habit High Med Low
Exercise
Saturday Diet
Stress
Sleep Overall Rating: /5
Light Mod Vig Habit High Med Low
Exercise
Sunday Diet
Stress
Sleep Overall Rating: /5
 RM 7–PA: Physical Activity Log
Name ________________ Grade ___
0 0 0 Total 0 0 0
Parent/Guardian Signature: Total Hours for the Week 3 0.0 0.0 Total Hours of Moderate to Vigorous Activity for the Week

Student Signature: ______________________________________ I hereby certify that this record is an accurate account of my physical activity participation.

Week of _______________________ Student's Daily Physical Activity Log for the Month of _____________________________________
Primary Health- Exercise
Health Habit Satisfaction Daily Reflection / Rating
Day Activity Related Fitness Intensity
Component Light Mod Vig Habit High Med Low
Exercise
Diet
Monday
Stress
Sleep Overall Rating: /5
Light Mod Vig Habit High Med Low
Exercise
Tuesday Diet
Stress
Sleep Overall Rating: /5
Light Mod Vig Habit High Med Low
Exercise
Wednesday Diet
Stress
Sleep Overall Rating: /5
Light Mod Vig Habit High Med Low
Exercise
Thursday Diet
Stress
Sleep Overall Rating: /5
Light Mod Vig Habit High Med Low
Exercise
Friday Diet
Stress
Sleep Overall Rating: /5
Light Mod Vig Habit High Med Low
Exercise
Saturday Diet
Stress
Sleep Overall Rating: /5
Light Mod Vig Habit High Med Low
Exercise
Sunday Diet
Stress
Sunday RM 7–PA: Physical Activity Log
Name ________________ Grade ___
Sleep Overall Rating: /5
0 0 0 Total 0 0 0
Total Hours for the Week 4 0.0 0.0 Total Hours of Moderate to Vigorous Activity for the Week
Parent/Guardian Signature: 0.0 Total Hours for the Month of 0.0 Total Hours of Moderate to Vigorous Activity for the Month

Student Signature: ______________________________________ I hereby certify that this record is an accurate account of my physical activity participation.
Exercise 0 0 0
Diet 0 0 0
Stress 0 0 0
Sleep 0 0 0
 RM 7–PA: Physical Activity Log
Name ________________ Grade ___

Week of _______________________ Student's Daily Physical Activity Log for the Month of _____________________________________
Primary Health- Exercise Time Health Habit Satisfaction Daily Reflection / Rating
Day Activity Related Fitness
Component Light Mod Vig Habit High Med Low
Exercise
Diet
Monday
Stress
Sleep Overall Rating: /5
Light Mod Vig Habit High Med Low
Exercise
Tuesday Diet
Stress
Sleep Overall Rating: /5
Light Mod Vig Habit High Med Low
Exercise
Wednesday Diet
Stress
Sleep Overall Rating: /5
Light Mod Vig Habit High Med Low
Exercise
Thursday Diet
Stress
Sleep Overall Rating: /5
Light Mod Vig Habit High Med Low
Exercise
Friday Diet
Stress
Sleep Overall Rating: /5
Light Mod Vig Habit High Med Low
Exercise
Saturday Diet
Stress
Sleep Overall Rating: /5
Light Mod Vig Habit High Med Low
Exercise
Sunday Diet
Stress
Sleep Overall Rating: /5
0 0 0 Total 0 0 0
Parent/Guardian Signature: Total Hours for the Week 1 0.0 0.0 Total Hours of Moderate to Vigorous Activity for the Week
 RM 7–PA: Physical Activity Log
Name ________________ Grade ___

Student Signature: ______________________________________ I hereby certify that this record is an accurate account of my physical activity participation.

Week of _______________________ Student's Daily Physical Activity Log for the Month of _____________________________________
Primary Health- Exercise Time Health Habit Satisfaction Daily Reflection / Rating
Day Activity Related Fitness
Component Light Mod Vig Habit High Med Low
Exercise
Diet
Monday
Stress
Sleep Overall Rating: /5
Light Mod Vig Habit High Med Low
Exercise
Tuesday Diet
Stress
Sleep Overall Rating: /5
Light Mod Vig Habit High Med Low
Exercise
Wednesday Diet
Stress
Sleep Overall Rating: /5
Light Mod Vig Habit High Med Low
Exercise
Thursday Diet
Stress
Sleep Overall Rating: /5
Light Mod Vig Habit High Med Low
Exercise
Friday Diet
Stress
Sleep Overall Rating: /5
Light Mod Vig Habit High Med Low
Exercise
Saturday Diet
Stress
Sleep Overall Rating: /5
Light Mod Vig Habit High Med Low
Exercise
Sunday Diet
Stress
Sleep Overall Rating: /5
0 0 0 Total 0 0 0
Parent/Guardian Signature:
 RM 7–PA: Physical Activity Log
Name ________________ Grade ___

Parent/Guardian Signature: Total Hours for the Week 2 0.0 0.0 Total Hours of Moderate to Vigorous Activity for the Week

Student Signature: ______________________________________ I hereby certify that this record is an accurate account of my physical activity participation.

Week of _______________________ Student's Daily Physical Activity Log for the Month of _____________________________________
Primary Health- Exercise Time Health Habit Satisfaction Daily Reflection / Rating
Day Activity Related Fitness
Component Light Mod Vig Habit High Med Low
Exercise
Diet
Monday
Stress
Sleep Overall Rating: /5
Light Mod Vig Habit High Med Low
Exercise
Tuesday Diet
Stress
Sleep Overall Rating: /5
Light Mod Vig Habit High Med Low
Exercise
Wednesday Diet
Stress
Sleep Overall Rating: /5
Light Mod Vig Habit High Med Low
Exercise
Thursday Diet
Stress
Sleep Overall Rating: /5
Light Mod Vig Habit High Med Low
Exercise
Friday Diet
Stress
Sleep Overall Rating: /5
Light Mod Vig Habit High Med Low
Exercise
Saturday Diet
Stress
Sleep Overall Rating: /5
Light Mod Vig Habit High Med Low
Exercise
Sunday Diet
Stress
Sleep Overall Rating: /5
 RM 7–PA: Physical Activity Log
Name ________________ Grade ___

0 0 0 Total 0 0 0
Parent/Guardian Signature: Total Hours for the Week 3 0.0 0.0 Total Hours of Moderate to Vigorous Activity for the Week

Student Signature: ______________________________________ I hereby certify that this record is an accurate account of my physical activity participation.

Week of _______________________ Student's Daily Physical Activity Log for the Month of _____________________________________
Primary Health- Exercise
Health Habit Satisfaction Daily Reflection / Rating
Day Activity Related Fitness Intensity
Component Light Mod Vig Habit High Med Low
Exercise
Diet
Monday
Stress
Sleep Overall Rating: /5
Light Mod Vig Habit High Med Low
Exercise
Tuesday Diet
Stress
Sleep Overall Rating: /5
Light Mod Vig Habit High Med Low
Exercise
Wednesday Diet
Stress
Sleep Overall Rating: /5
Light Mod Vig Habit High Med Low
Exercise
Thursday Diet
Stress
Sleep Overall Rating: /5
Light Mod Vig Habit High Med Low
Exercise
Friday Diet
Stress
Sleep Overall Rating: /5
Light Mod Vig Habit High Med Low
Exercise
Saturday Diet
Stress
Sleep Overall Rating: /5
Light Mod Vig Habit High Med Low
Exercise
Sunday Diet
Stress
 RM 7–PA: Physical Activity Log
Name ________________
Sunday Grade ___

Sleep Overall Rating: /5

0 0 0 Total 0 0 0
Total Hours for the Week 4 0.0 0.0 Total Hours of Moderate to Vigorous Activity for the Week
Parent/Guardian Signature: 0.0 Total Hours for the Month of 0.0 Total Hours of Moderate to Vigorous Activity for the Month

Student Signature: ______________________________________ I hereby certify that this record is an accurate account of my physical activity participation.
Exercise 0 0 0
Diet 0 0 0
Stress 0 0 0
Sleep 0 0 0
 Name ___________________ RM 7–PA: Physical Activity Log Grade ___

Week of: Student's Daily Physical Activity Log for the Month of _____________________________________
Primary Health- Exercise Time Health Habit Satisfaction Daily Reflection / Rating
Day Activity Related Fitness
Component Light Mod Vig Habit High Med Low
Exercise
Diet
Monday
Stress
Sleep Overall Rating: /5
Light Mod Vig Habit High Med Low
Exercise
Tuesday Diet
Stress
Sleep Overall Rating: /5
Light Mod Vig Habit High Med Low
Exercise
Wednesday Diet
Stress
Sleep Overall Rating: /5
Light Mod Vig Habit High Med Low
Exercise
Thursday Diet
Stress
Sleep Overall Rating: /5
Light Mod Vig Habit High Med Low
Exercise
Friday Diet
Stress
Sleep Overall Rating: /5
Light Mod Vig Habit High Med Low
Exercise
Saturday Diet
Stress
Sleep Overall Rating: /5
Light Mod Vig Habit High Med Low
Exercise
Sunday Diet
Stress
Sleep Overall Rating: /5
0 0 0 Total 0 0 0
Parent/Guardian Signature: Total Hours for the Week 1 0.0 0.0 Total Hours of Moderate to Vigorous Activity for the Week
 Name ___________________ RM 7–PA: Physical Activity Log Grade ___

Student Signature: ______________________________________ I hereby certify that this record is an accurate account of my physical activity participation.

Week of: Student's Daily Physical Activity Log for the Month of _____________________________________
Primary Health- Exercise Time Health Habit Satisfaction Daily Reflection / Rating
Day Activity Related Fitness
Component Light Mod Vig Habit High Med Low
Exercise
Diet
Monday
Stress
Sleep Overall Rating: /5
Light Mod Vig Habit High Med Low
Exercise
Tuesday Diet
Stress
Sleep Overall Rating: /5
Light Mod Vig Habit High Med Low
Exercise
Wednesday Diet
Stress
Sleep Overall Rating: /5
Light Mod Vig Habit High Med Low
Exercise
Thursday Diet
Stress
Sleep Overall Rating: /5
Light Mod Vig Habit High Med Low
Exercise
Friday Diet
Stress
Sleep Overall Rating: /5
Light Mod Vig Habit High Med Low
Exercise
Saturday Diet
Stress
Sleep Overall Rating: /5
Light Mod Vig Habit High Med Low
Exercise
Sunday Diet
Stress
Sleep Overall Rating: /5
0 0 0 Total 0 0 0
Parent/Guardian Signature:
 Name ___________________ RM 7–PA: Physical Activity Log Grade ___

Parent/Guardian Signature: Total Hours for the Week 2 0.0 0.0 Total Hours of Moderate to Vigorous Activity for the Week

Student Signature: ______________________________________ I hereby certify that this record is an accurate account of my physical activity participation.

Week of: Student's Daily Physical Activity Log for the Month of _____________________________________
Primary Health- Exercise Time Health Habit Satisfaction Daily Reflection / Rating
Day Activity Related Fitness
Component Light Mod Vig Habit High Med Low
Exercise
Diet
Monday
Stress
Sleep Overall Rating: /5
Light Mod Vig Habit High Med Low
Exercise
Tuesday Diet
Stress
Sleep Overall Rating: /5
Light Mod Vig Habit High Med Low
Exercise
Wednesday Diet
Stress
Sleep Overall Rating: /5
Light Mod Vig Habit High Med Low
Exercise
Thursday Diet
Stress
Sleep Overall Rating: /5
Light Mod Vig Habit High Med Low
Exercise
Friday Diet
Stress
Sleep Overall Rating: /5
Light Mod Vig Habit High Med Low
Exercise
Saturday Diet
Stress
Sleep Overall Rating: /5
Light Mod Vig Habit High Med Low
Exercise
Sunday Diet
Stress
Sleep Overall Rating: /5
 Name ___________________ RM 7–PA: Physical Activity Log Grade ___

0 0 0 Total 0 0 0
Parent/Guardian Signature: Total Hours for the Week 3 0.0 0.0 Total Hours of Moderate to Vigorous Activity for the Week

Student Signature: ______________________________________ I hereby certify that this record is an accurate account of my physical activity participation.

Week of: Student's Daily Physical Activity Log for the Month of _____________________________________
Primary Health- Exercise
Health Habit Satisfaction Daily Reflection / Rating
Day Activity Related Fitness Intensity
Component Light Mod Vig Habit High Med Low
Exercise
Diet
Monday
Stress
Sleep Overall Rating: /5
Light Mod Vig Habit High Med Low
Exercise
Tuesday Diet
Stress
Sleep Overall Rating: /5
Light Mod Vig Habit High Med Low
Exercise
Wednesday Diet
Stress
Sleep Overall Rating: /5
Light Mod Vig Habit High Med Low
Exercise
Thursday Diet
Stress
Sleep Overall Rating: /5
Light Mod Vig Habit High Med Low
Exercise
Friday Diet
Stress
Sleep Overall Rating: /5
Light Mod Vig Habit High Med Low
Exercise
Saturday Diet
Stress
Sleep Overall Rating: /5
Light Mod Vig Habit High Med Low
Exercise
Sunday Diet
Stress
 Name ___________________
Sunday
RM 7–PA: Physical Activity Log Grade ___

Sleep Overall Rating: /5

0 0 0 Total 0 0 0
Total Hours for the Week 4 0.0 0.0 Total Hours of Moderate to Vigorous Activity for the Week
Parent/Guardian Signature: 0.0 Total Hours for the Month of 0.0 Total Hours of Moderate to Vigorous Activity for the Month

Student Signature: ______________________________________ I hereby certify that this record is an accurate account of my physical activity participation.
Exercise 0 0 0
Diet 0 0 0
Stress 0 0 0
Sleep 0 0 0
 RM 7–PA: Physical Activity Log (Summary)

Name ____________________________________________ Grade _________

1st Month Total Time Spent in Physical Activity for Week 1 0 Hours

Total Time Spent in Physical Activity for Week 2 0 Hours

Total Time Spent in Physical Activity for Week 3 0 Hours

Total Time Spent in Physical Activity for Week 4 0 Hours

Total Time Spent in Physical Activity for Month 1 0 Hours

Total Time Spent in Moderate to Vigorous Range for Month 1 0.0 Hours

Health Habit Satisfaction for Month 1 High Med. Low

Exercise 0 0 0
Diet 0 0 0
Stress 0 0 0
Sleep 0 0 0

2nd Month Total Time Spent in Physical Activity for Week 1 0 Hours

Total Time Spent in Physical Activity for Week 2 0 Hours

Total Time Spent in Physical Activity for Week 3 0 Hours

Total Time Spent in Physical Activity for Week 4 0 Hours

Total Time Spent in Physical Activity for Month 2 0 Hours

Total Time Spent in Moderate to Vigorous Range for Month 1 0.0 Hours

Health Habit Satisfaction for Month 2 High Med. Low

Exercise 0 0 0
Diet 0 0 0
Stress 0 0 0
Sleep 0 0 0

3rd Month Total Time Spent in Physical Activity for Week 1 0 Hours

Total Time Spent in Physical Activity for Week 2 0 Hours

Total Time Spent in Physical Activity for Week 3 0 Hours

Total Time Spent in Physical Activity for Week 4 0 Hours

Total Time Spent in Physical Activity for Month 3 0 Hours

Total Time Spent in Moderate to Vigorous Range for Month 1 0.0 Hours

Health Habit Satisfaction for Month 3 High Med. Low

Exercise 0 0 0
Diet 0 0 0
Stress 0 0 0
 RM 7–PA: Physical Activity Log (Summary)

Sleep 0 0 0

4th Month Total Time Spent in Physical Activity for Week 1 0 Hours

Total Time Spent in Physical Activity for Week 2 0 Hours

Total Time Spent in Physical Activity for Week 3 0 Hours

Total Time Spent in Physical Activity for Week 4 0 Hours

Total Time Spent in Physical Activity for Month 4 0 Hours

Total Time Spent in Moderate to Vigorous Range for Month 1 0.0 Hours

Health Habit Satisfaction for Month 4 High Med. Low

Exercise 0 0 0
Diet 0 0 0
Stress 0 0 0
Sleep 0 0 0

5th Month Total Time Spent in Physical Activity for Week 1 0 Hours

Total Time Spent in Physical Activity for Week 2 0 Hours

Total Time Spent in Physical Activity for Week 3 0 Hours

Total Time Spent in Physical Activity for Week 4 0 Hours

Total Time Spent in Physical Activity for Month 5 0 Hours

Total Time Spent in Moderate to Vigorous Range for Month 1 0.0 Hours

Health Habit Satisfaction for Month 5 High Med. Low

Exercise 0 0 0
Diet 0 0 0
Stress 0 0 0
Sleep 0 0 0

Course Summary

Total Time Spent in Physical Activity for the Course 0.0 Hours

Total Time Spent in Moderate to Vigorous Range for the Course 0.0 Hours

Health Habit Satisfaction for the Course High Med. Low

Exercise 0 0 0
Diet 0 0 0
Stress 0 0 0
Sleep 0 0 0
 My Physical Activity Plan/Log for the Month of ________________________

Sunday Monday Tuesday Wednesday Thursday Friday Saturday