Sensory Diet Details Chart
ADVERTISEMENT
1
2Name:
Olivia
I tried:
After the activity, I felt:
This activity made me
I’m feeling:
Date:
Time:
(write name of the activity)
(circle all that apply)
feel
(circle the face that matches how you feel)
(circle one answer):
Brush teeth with a
Monday
8am
vibrating toothbrush
overexcited
anxious
sleepy
angry
calm
overexcited
anxious
sleepy
angry
calm
worse
the same
better
Wear noise-canceling
Tuesday
4pm
headphones
worse
the same
better
overexcited
anxious
sleepy
angry
calm
overexcited
anxious
sleepy
angry
calm
Carry a full laundry
Wednesday
7pm
basket
worse
the same
better
overexcited
anxious
sleepy
angry
calm
overexcited
anxious
sleepy
angry
calm
Thursday
7am
Ride bike
worse
the same
better
overexcited
anxious
sleepy
angry
calm
overexcited
anxious
sleepy
angry
calm
Friday
12pm
Apply scented lip balm
worse
the same
better
overexcited
anxious
sleepy
angry
calm
overexcited
anxious
sleepy
angry
calm
Brush teeth with a
Saturday
8am
vibrating toothbrush
worse
the same
better
overexcited
anxious
sleepy
angry
calm
overexcited
anxious
sleepy
angry
calm
Use calming sensory
Sunday
4pm
bottles
worse
the same
better
overexcited
anxious
sleepy
angry
calm
overexcited
anxious
sleepy
angry
calm
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Miscellaneous