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Daily Activity
Log:
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Date : |
Begin
Time
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End
Time
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Total
Hours
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Keep
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Change |
Type of change needed: |
| 1. |
Sleeping |
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| 2. |
Resting or lying quietly |
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| 3. |
Personal grooming |
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| 4. |
Planing your day |
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| 5. |
Planning your
future |
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| 6. |
Planning your career |
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| 7. |
Maintaining your journal
or memory book |
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| 8. |
Medical appointments |
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| 9. |
Meal planning and preparation |
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| 10. |
Shopping for food |
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| 11. |
Direct care of a child or children |
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| 12. |
Caregiving for an adult |
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| 13. |
Care of animals / pets |
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| 14. |
Supervising others |
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| 15. |
Housecleaning |
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| 16. |
Laundry |
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| 17. |
Maintenance of home |
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| 18. |
Maintenance of self |
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| 19. |
Yard work - gardening |
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| 20. |
Maintenance of car |
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| 21. |
Opening Mail |
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| 22. |
Coffee break |
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| 23. |
Social obligations |
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| 24. |
Running errands |
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| 25. |
Family obligations |
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| 26. |
Commuting |
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| 27. |
Employment |
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| 28. |
Building skills - self improvement |
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| 29. |
School work |
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| 30. |
Community or civic obligations |
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| 31. |
Talking with colleagues |
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| 32. |
Sitting at the computer |
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| 33. |
Sitting in meetings |
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| 34. |
Watching TV / videos |
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| 35. |
Walking / Jogging / other exercise |
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| 36. |
Climbing stairs |
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| 37. |
Other physical activities (describe) |
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| 38. |
Managing family or personal affairs |
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| 39. |
Reflecting on the beauty and joy of life |
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| 40. |
Relaxing, reflecting, enjoying music, praying, etc. |
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| 41. |
Feeling competent and self-assured |
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| 42. |
Thanking those who have helped you |
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| 43. |
Feeling lethargic unable to get going |
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| 44. |
Feeling disoriented - scattered, unable to focus |
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| 45. |
Feeling agitated, unable to settle down |
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| 46. |
Checking and rechecking everything you do |
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| 47. |
Feeling depressed or blue |
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| 48. |
Feeling worthless |
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| 49. |
Self-deprecating thoughts |
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| 50. |
Thoughts of doing harm to yourself or others |
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| 51. |
Troublesome thoughts about your future |
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| 52. |
Worrying about money |
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| 53. |
Worrying about how others see you |
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| 54. |
Ruminating over insults and slights of others |
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| 55. |
Dealing with difficult or annoying people |
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| 56. |
Unexpected company |
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| 57. |
Too much time on your hands |
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| 58. |
Feeling lonely |
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| 59. |
Wasting time |
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| 60. |
Wishing things would be better |
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| 61. |
Drinking or doing drugs |
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| 62. |
Confrontations with others |
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| 63. |
Other - describe |
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| 64. |
Other - describe |
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| 65. |
Other - describe |
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Total # should equal 24 hours |
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