Purpose: This questionnaire helps assess your typical daily activities, including physical, mental, and emotional habits. It aims to identify areas where adjustments may improve your overall well-being.

This document, which will continue to be updated throughout the season, is a Checklist of Daily Activities to help us continue to “Work the Wheel” and practice growing our strengths.

Measure for developing functional benchmarks and examining functional outcomes over an episode of post acute care. Completed by having the patient answer the question or complete the activity. …

Date Please check the one best response for each activity described below: Sedentary Behavior Sitting while watching TV, at a computer, driving, talking on the phone, or reading

How many times did you wake up or get out of bed? How long did it take you to fall asleep?): Extra comments about today (Extra medicine taken? Stress level? Mood? Weather? Other?): (Are physical …

My Physical Activity Diary Week: __________________ Time of Day Description of Activity Description of Activity Duration

DAILY ACTIVITY AND REST DIARY Day Slept for (hours) Awake at (time) 8–9am 9–10am 10–11am 11–12noon