A form on which you can record in detail what you are currently doing during the day, how long you do it for and whether it is High, Medium or Low energy use. You could use this form for a couple of days if your daily routine does not vary much, or for longer if your days vary over a week or two. Build up a picture of how you spend your energy and consider the strengths and weaknesses of your current lifestyle in relation to your management of the ME/CFS. You can then use this completed form to help you design a more balanced routine on the Daily/Weekly Planner. If your daily routine does not need to be recorded in detail you may wish to use the Weekly Record of Activity Form instead to build up a picture of your current activity. There are 2 completed examples and 2 blank templates of this form.
Blank forms are available in Word or PDF format. Example forms are available in PDF format only. Click on either the Word or PDF link below the form to open the document on your computer. Alternatively, right click on any form and choose "Save picture as..." to save it as a JPEG to your computer. Forms may be edited and printed to suit your needs.
Blank - DAILY RECORD OF ACTIVITY
Example - DAILY RECORD OF ACTIVITY