After-School Routine Checklist
Track and confirm completion of daily after-school tasks.
Student Full Name
*
First Name
Last Name
Date
*
-
Month
-
Day
Year
Date
Grade/Class
*
Please Select
Kindergarten
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
6th Grade
7th Grade
8th Grade
Other
After-School Tasks Completed (Check all that apply)
*
Had a healthy snack
Completed homework
Read for at least 20 minutes
Did chores (e.g., tidy room, help with dishes)
Physical activity (indoor/outdoor play, sports)
Prepared school bag for next day
Other (please specify)
If you selected 'Other', please specify the task(s) completed:
How would you rate your effort today?
1
2
3
4
5
Did you need help with any tasks today?
*
Yes
No
If yes, who helped you? (Parent, sibling, etc.)
Any comments or notes about today’s routine?
Who is completing this checklist?
*
Student
Parent/Guardian
Submit Checklist
Should be Empty: