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
4. In the level).
intensity 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 I worked hard on the lesson. We started to discover handball and it
was interesting. It turned out that I have good abilities in this sport.
PE X ( 45
minutes ) Exercise X Also, I received 12 thank to my high effort.
Diet X
Monday
Stress X
Sleep X Overall Rating: 5 /5
Light Mod Vig Habit High Med Low Today we played football with our class. Our opponents were 8
classes and they are really hard players. It was easy training, but
Football ! Exercise however it was healthy for us
Tuesday Diet
Stress
Sleep Overall Rating: 3/5
Light Mod Vig Habit High Med Low
Swimming Exercise
Wednesday Diet
Stress
Sleep Overall Rating: /5
Light Mod Vig Habit High Med Low
PE Exercise
Thursday Diet
Stress
Sleep Overall Rating: /5
Light Mod Vig Habit High Med Low
Swimming Exercise
Friday Diet
Stress
Sleep Overall Rating: /5
Light Mod Vig Habit High Med Low
Boxing 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 1 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

Sunday
Name ___________________________ RM 7–PA: Physical Activity Log Grade _____

Exercise
Sunday Diet
Stress
Sleep Overall Rating: /5
0 0 0 Total 0 0 0
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
PE Exercise
This lesson I was absent because of my cold :(
Diet
Monday
Stress
Sleep Overall Rating: 0 /5
Light Mod Vig Habit High Med Low
Football Exercise
In Tuesday I was also absent because of my cold :(
Tuesday Diet
Stress
Sleep Overall Rating: 0 /5
Light Mod Vig Habit High Med Low
Swimming 1 hour Exercise X Today I visit my first training after short illness. I worked in
middle mode because I was not ready for 100 %, but it was still
Wednesday Diet X a good workout for my body.
Stress X
Sleep X Overall Rating: 3 /5
Light Mod Vig Habit High Med Low
PE Exercise
Today I was absent on PE because I overslept the first lesson.
Thursday Diet
Stress
Sleep Overall Rating: 0 /5
Light Mod Vig Habit High Med Low
Swimming Exercise X Today I had a good training. I gave my best and performed
difficult tasks to re-enter my training regime. My coach was
Friday 1 hour Diet X pleased with me. After training, I ate well and felt tired.
Stress X
Sleep X Overall Rating: 5 /5
Light Mod Vig Habit High Med Low Today I had a boxing training. It was morning so I was a little
Boxing 1 hour Exercise X out of my mind and it was difficult for me to start working, but
when I started doing punches I immediately came to my senses
Saturday and did a good job. I felt good after training and recharge for
the whole day
Name ___________________________ RM 7–PA: Physical Activity Log Grade _____

Today I had a boxing training. It was morning so I was a little

out of my mind and it was difficult for me to start working, but
when I started doing punches I immediately came to my senses
Saturday Diet X and did a good job. I felt good after training and recharge for
the whole day
Stress X
Sleep X Overall Rating: 4 /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 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 Intensity 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
Name ___________________________ RM 7–PA: Physical Activity Log Grade _____

Friday
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
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
Name ______________________ RM 7–PA: Physical Activity Log Grade ____

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

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

Sunday
Name ______________________ RM 7–PA: Physical Activity Log Grade ____

Exercise
Sunday Diet
Stress
Sleep Overall Rating: /5
0 0 0 Total 0 0 0
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
Name ______________________ RM 7–PA: Physical Activity Log Grade ____

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 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 Intensity 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
Name ______________________ RM 7–PA: Physical Activity Log Grade ____

Friday
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
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
Name ________________ RM 7–PA: Physical Activity Log Grade ___

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

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

Sunday
Name ________________ RM 7–PA: Physical Activity Log Grade ___

Exercise
Sunday Diet
Stress
Sleep Overall Rating: /5
0 0 0 Total 0 0 0
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
Name ________________ RM 7–PA: Physical Activity Log Grade ___

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 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 Intensity 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
Name ________________ RM 7–PA: Physical Activity Log Grade ___

Friday
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
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
Name ________________ RM 7–PA: Physical Activity Log Grade ___

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

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

Sunday
Name ________________ RM 7–PA: Physical Activity Log Grade ___

Exercise
Sunday Diet
Stress
Sleep Overall Rating: /5
0 0 0 Total 0 0 0
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
Name ________________ RM 7–PA: Physical Activity Log Grade ___

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 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 Intensity 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
Name ________________ RM 7–PA: Physical Activity Log Grade ___

Friday
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
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
Name ___________________ RM 7–PA: Physical Activity Log Grade ___

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

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

Sunday
Name ___________________ RM 7–PA: Physical Activity Log Grade ___

Exercise
Sunday Diet
Stress
Sleep Overall Rating: /5
0 0 0 Total 0 0 0
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
Name ___________________ RM 7–PA: Physical Activity Log Grade ___

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 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 Intensity 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
Name ___________________ RM 7–PA: Physical Activity Log Grade ___

Friday
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
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 0.0 Hours

Total Time Spent in Physical Activity for Week 2 0.0 Hours

Total Time Spent in Physical Activity for Week 3 0.0 Hours

Total Time Spent in Physical Activity for Week 4 0.0 Hours

Total Time Spent in Physical Activity for Month 1 0.0 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 0.0 Hours

Total Time Spent in Physical Activity for Week 2 0.0 Hours

Total Time Spent in Physical Activity for Week 3 0.0 Hours

Total Time Spent in Physical Activity for Week 4 0.0 Hours

Total Time Spent in Physical Activity for Month 2 0.0 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 0.0 Hours
 RM 7–PA: Physical Activity Log (Summary)

Total Time Spent in Physical Activity for Week 2 0.0 Hours

Total Time Spent in Physical Activity for Week 3 0.0 Hours

Total Time Spent in Physical Activity for Week 4 0.0 Hours

Total Time Spent in Physical Activity for Month 3 0.0 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
Sleep 0 0 0

4th Month Total Time Spent in Physical Activity for Week 1 0.0 Hours

Total Time Spent in Physical Activity for Week 2 0.0 Hours

Total Time Spent in Physical Activity for Week 3 0.0 Hours

Total Time Spent in Physical Activity for Week 4 0.0 Hours

Total Time Spent in Physical Activity for Month 4 0.0 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 0.0 Hours

Total Time Spent in Physical Activity for Week 2 0.0 Hours

Total Time Spent in Physical Activity for Week 3 0.0 Hours

Total Time Spent in Physical Activity for Week 4 0.0 Hours

 RM 7–PA: Physical Activity Log (Summary)

Total Time Spent in Physical Activity for Month 5 0.0 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 OCTOBER

Sunday Monday Tuesday Wednesday Thursday Friday

Nothing PE ( 45 minutes ) Football in school Swimming ( 1 hour ) PE ( 45 minutes ) Swimming ( 1 hour )

( 30 minutes )

Nothing PE ( 45 minutes ) Football in school Swimming ( 1 hour ) PE ( 45 minutes ) Swimming ( 1 hour )

( 30 minutes )

Football in school
Nothing PE ( 45 minutes ) ( 30 minutes ) Swimming ( 1 hour ) PE ( 45 minutes ) Swimming ( 1 hour )

Football in school
Nothing PE ( 45 minutes ) ( 30 minutes ) Swimming ( 1 hour ) PE ( 45 minutes ) Swimming ( 1 hour )
 Football in school
Nothing PE ( 45 minutes ) ( 30 minutes ) Swimming ( 1 hour ) PE ( 45 minutes ) Swimming ( 1 hour )
 Saturday

BOX ( 1:30 hours )

BOX ( 1:30 hours )

BOX ( 1:30 hours )

BOX ( 1:30 hours )

BOX ( 1:30 hours )