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HS1901Fall2021activitylog1.xls

PreChange

Days Minutes of Fill In the Blank
Sept. 13 0
Sept. 14 10
Sept. 15 2
Sept. 16 0
Sept. 17 3
Sept. 18 7
Sept.19 5
Your Name: Fill in the Blank
Approved SMART Goal: Write the exact goal you submitted and was approved
Short Term Goal 1: Fill In the blank
Short Term Goal 2: Fill in the blank
Short Term Goal 3: Fill in the blank
ACTIVITY LOG
Date Range: 9/13/2021 - 9/19/2021
Instructions: Please provide specific numbers/times/frequency/amounts in the columns in order to easily convert into graphs for the specific week (date) range
Behavior/Activity Duration/Quantity Thoughts/Feelings Notes/Ideas
Monday 0
Tuesday 10
Wednesday 2
Thursday 0
Friday 3
Saturday 7
Sunday 5
Total: 27

PreChange

Pre Change Week

Week 1

Week # Week Dates Minutes of ______ (type in the name of your approved behavior)
PreChange Sept. 13-19 27
Week 1 Sept. 20-26 30
Your Name: Fill in the Blank
Approved SMART Goal: Write Exact Goal
Short Term Goal 1: Fill in the Blank
Short Term Goal 2: fill in the blank
Short Term Goal 3: fill in the blank
ACTIVITY LOG
Date Range Sept. 20-26
Instructions: Please provide specific numbers/times/frequency/amounts in the columns in order to easily convert into graphs for the specific week (date) range
Behavior/Activity Duration/Quantity Thoughts/Feelings Notes/Ideas
Monday 4
Tuesday 4
Wednesday 5
Thursday 4
Friday 5
Saturday 4
Sunday 4
Total 30
Kerry Kampschroeder: I got this figure by adding the daily amounts on sheet 1.
Elizabeth Wachira: Total duration/quantity inputed into graph
Elizabeth Wachira: TOTAL Minutes
Elizabeth Wachira: Total from Activity log

Week 1

Minutes of ______ (type in the name of your approved behavior)
PreChange and Week 1 Activity

Week 2

Week # Week Dates Minutes of Fill in the Blank
Pre-Change Sept. 13-19 27
Week 1 Sept. 20 - 26 30
Week 2 Type in dates 3
Your Name: Be sure to complete this section
Approved SMART Goal:
Short Term Goal 1:
Short Term Goal 2:
Short Term Goal 3:
ACTIVITY LOG
Date Range: Type in dates
Instructions: Please provide specific numbers/times/frequency/amounts in the columns in order to easily convert into graphs for the specific week (date) range
Behavior/Activity Duration/Quantity Thoughts/Feelings Notes/Ideas
Monday
Tuesday
Wednesday 3
Thursday
Friday
Saturday
Sunday
Total 3

Week 2

Minutes of Fill in the Blank
PreChange through Week 2 Activity

Week 3

Week # Week Dates Minutes of Fill in the Blank
PreChange Sept. 13-19 27
Week 1 Sept. 20-26 30
Week 2 Sept. 27 - Oct. 3 3
Week 3 Type in dates 3
Your Name: Be sure to complete this entire section icluding goals.
Approved SMART Goal:
Short Term Goal 1:
Short Term Goal 2:
Short Term Goal 3:
ACTIVITY LOG
Date Range: Type in dates
Instructions: Please provide specific numbers/times/frequency/amounts in the columns in order to easily convert into graphs for the specific week (date) range
Behavior/Activity Duration/Quantity Thoughts/Feelings Notes/Ideas
Monday
Tuesday 3
Wednesday
Thursday
Friday
Saturday
Sunday
Total 3

Week 3

Minutes of Fill in the Blank
PreChange through Week 3 Activity

Week 4

Week # Week Dates Minutes of Fill in the Blank
PreChange Sept. 13-19 27
Week 1 Sept. 20-26 30
Week 2 Sept. 27 - Oct. 3 3
Week 3 Oct. 4-10 3
Week 4 Type in dates 4
Your Name: Complete this entire section, including goals.
Approved SMART Goal:
Short Term Goal 1:
Short Term Goal 2:
Short Term Goal 3:
ACTIVITY LOG
Date Range: Type in dates
Instructions: Please provide specific numbers/times/frequency/amounts in the columns in order to easily convert into graphs for the specific week (date) range
Behavior/Activity Duration/Quantity Thoughts/Feelings Notes/Ideas
Monday
Tuesday
Wednesday 4
Thursday
Friday
Saturday
Sunday
Total 4

Week 4

Minutes of Fill in the Blank
PreChange through Week 4

Spring Break

Week # Week Dates Minutes of Fill in the Blank
PreChange Feb 4-10 27
Week 1 Feb. 11-17 30
Week 2 Feb. 18-24 3
Week 3 Feb. 25 - Mar. 3 3
Week 4 Mar. 4-10 4
Spring Break Mar. 11-17 0
Your Name: Complete this section
Approved SMART Goal:
Short Term Goal 1:
Short Term Goal 2:
Short Term Goal 3:
ACTIVITY LOG
Date Range: Mar. 11-17
Instructions: Please provide specific numbers/times/frequency/amounts in the columns in order to easily convert into graphs for the specific week (date) range
Behavior/Activity Duration/Quantity Thoughts/Feelings Notes/Ideas
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Total 0

Spring Break

Minutes of Fill in the Blank
PreChange through Spring Break Activity

Week 5

Week # Week Dates Minutes of Fill in the Blank
PreChange Sept. 13-19 27
Week 1 Sept. 20-26 30
Week 2 Sept. 27 - Oct. 3 3
Week 3 Oct. 4 - 10 3
Week 4 Oct. 11-17 4
Week 5 fill in date 6
Your Name: Complete this ENTIRE section, including goals
Approved SMART Goal:
Short Term Goal 1:
Short Term Goal 2:
Short Term Goal 3:
ACTIVITY LOG
Date Range: fill in date
Instructions: Please provide specific numbers/times/frequency/amounts in the columns in order to easily convert into graphs for the specific week (date) range
Behavior/Activity Duration/Quantity Thoughts/Feelings Notes/Ideas
Monday
Tuesday
Wednesday
Thursday 6
Friday
Saturday
Sunday
Total 6

Week 5

Minutes of Fill in the Blank
Pre Change Through Week 5

Week 6

Week # Week Dates Minutes of Fill in Blank
PreChange Sept. 13-19 27
Week 1 Sept. 20-26 30
Week 2 Sept. 27 - Oct. 3 3
Week 3 Oct. 4-10 3
Week 4 Oct. 11-17 4
Week 5 Oct. 18-24 6
Week 6 fill in the date 4
Your Name: Complete this section
Approved SMART Goal:
Short Term Goal 1:
Short Term Goal 2:
Short Term Goal 3:
ACTIVITY LOG
Date Range: fill in the date
Instructions: Please provide specific numbers/times/frequency/amounts in the columns in order to easily convert into graphs for the specific week (date) range
Behavior/Activity Duration/Quantity Thoughts/Feelings Notes/Ideas
Monday
Tuesday
Wednesday
Thursday 4
Friday
Saturday
Sunday
Total 4

Week 6

Pre Change Through Week 6

Week 7

Week # Week Dates Minutes of Fill in Blank
PreChange Sept. 13-19 27
Week 1 Sept. 20-26 30
Week 2 Sept. 27 -Oct. 3 3
Week 3 Oct. 4-10 3
Week 4 Oct. 11-17 4
Week 5 Oct. 18-24 6
Week 6 Oct. 25-31 4
Week 7 Nov. 1-7 2
Your Name: Complete this section
Approved SMART Goal:
Short Term Goal 1:
Short Term Goal 2:
Short Term Goal 3:
ACTIVITY LOG
Date Range: Nov. 1-7
Instructions: Please provide specific numbers/times/frequency/amounts in the columns in order to easily convert into graphs for the specific week (date) range
Behavior/Activity Duration/Quantity Thoughts/Feelings Notes/Ideas
Monday
Tuesday 2
Wednesday
Thursday
Friday
Saturday
Sunday
Total 2

Week 7

Pre Change Through Week 7

PostChange Week

Days Minutes of Fill in the Blank
Nov. 8 0
Nov. 9 0
Nov. 10 0
Nov. 11 0
Nov. 12 0
Nov. 13 0
Nov. 14 0
Your Name:
Approved SMART Goal: Complete this section
Short Term Goal 1:
Short Term Goal 2:
Short Term Goal 3:
ACTIVITY LOG
Date Range: Nov. 8-14, 2021
Instructions: Please provide specific numbers/times/frequency/amounts in the columns in order to easily convert into graphs for the specific week (date) range
Behavior/Activity Duration/Quantity Thoughts/Feelings Notes/Ideas
Monday
Tuesday
Wednesday
Thursday 1
Friday
Saturday
Sunday
Total 1

PostChange Week

Minutes of Fill in the Blank
Post Change Week

9 Week Graph

Week # Week Dates Minutes of Fill in the Blank
PreChange Sept. 13-19 27
Week 1 Sept. 20-26 30
Week 2 Sept. 27-Oct. 3 3
Week 3 Oct. 4-10 3
Week 4 Oct. 11 - 17 4
Week 5 Oct. 18 - Oct. 24 6
Week 6 Oct. 24-31 4
Week 7 Nov. 1-7 2
Post Change Nov. 8-14 1
Your Name: Complete this section
Approved SMART Goal:
Short Term Goal 1:
Short Term Goal 2:
Short Term Goal 3:
Kerry Kampschroeder: I got this figure by adding the daily amounts on sheet 1.

9 Week Graph

9 Week Bar Graph Fall 2020