Child Online Activity Report Form
Please provide detailed information about the child's online activities for the specified reporting period.
Child's Full Name
*
First Name
Last Name
Child's Age
*
Reporting Period
*
Please Select
This week
Last week
This month
Last month
Custom (please specify below)
If 'Custom', please specify the reporting period (dates)
Devices Used for Online Activities
*
Smartphone
Tablet
Laptop/Computer
Game Console
Smart TV
Other
Types of Online Activities
*
Social Media (e.g., Instagram, TikTok)
Online Gaming
Educational Platforms
Video Streaming (e.g., YouTube)
Messaging/Chat Apps
Other
Frequency and Duration of Online Activities
*
Rows
Frequency (per week)
Average Duration (per session)
Social Media
0-2 times
3-5 times
6-10 times
More than 10 times
Less than 30 minutes
30-60 minutes
1-2 hours
More than 2 hours
Online Gaming
0-2 times
3-5 times
6-10 times
More than 10 times
Less than 30 minutes
30-60 minutes
1-2 hours
More than 2 hours
Educational Platforms
0-2 times
3-5 times
6-10 times
More than 10 times
Less than 30 minutes
30-60 minutes
1-2 hours
More than 2 hours
Video Streaming
0-2 times
3-5 times
6-10 times
More than 10 times
Less than 30 minutes
30-60 minutes
1-2 hours
More than 2 hours
Messaging/Chat Apps
0-2 times
3-5 times
6-10 times
More than 10 times
Less than 30 minutes
30-60 minutes
1-2 hours
More than 2 hours
Level of Adult Supervision During Online Activities
*
Always supervised
Mostly supervised
Sometimes supervised
Rarely supervised
Never supervised
Any Concerns or Incidents Observed (e.g., exposure to inappropriate content, cyberbullying, excessive use, privacy concerns)
Additional Comments or Recommendations
Your Name (Person Completing the Report)
*
First Name
Last Name
Your Relationship to the Child
*
Please Select
Parent/Guardian
Teacher/Educator
Counselor
Other
Contact Email (for follow-up, if needed)
example@example.com
Submit Report
Should be Empty: