Abnormal Stool Observation Log Form
Please record details of any abnormal stool episodes for accurate health tracking.
Reporter Name
*
First Name
Last Name
Observation Date and Time
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Hour Minutes
AM
PM
AM/PM Option
Frequency of Abnormal Episodes in the Past 24 Hours
*
Stool Appearance (Shape/Form)
*
Watery
Loose
Mucous
Bloody
Pasty
Other
Stool Color
*
Brown
Yellow
Green
Black
Red
Clay/Gray
Other
Stool Texture/Consistency
*
Hard
Formed
Soft
Loose
Watery
Other
Associated Symptoms
*
Abdominal pain
Fever
Nausea/Vomiting
Dehydration
Fatigue
Blood in stool
No additional symptoms
Other
Possible Triggers or Exposures
*
New medication
Dietary change
Recent travel
Ill contacts
Food poisoning
No known triggers
Other
Actions Taken
*
Increased fluid intake
Took medication
Sought medical advice
No action taken
Other
Additional Notes
Submit Log
Should be Empty: