First Responder Health Cycle Tracking Log Form
Log your daily health cycle and wellness activities as a first responder. This form is designed for general tracking purposes only.
Full Name
*
First Name
Last Name
Role / Position
*
Please Select
Paramedic
Firefighter
Police Officer
EMT
Dispatcher
Other
Date of Log Entry
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Shift Type
*
Day
Night
Split
On Call
Hours Worked This Shift
*
General Wellness Status
*
Excellent
Good
Fair
Needs Attention
Physical Activity During Shift
Walking/Patrolling
Lifting/Carrying
Emergency Response
Training/Drills
Other
Hydration Level
Well Hydrated
Adequate
Needs Improvement
Rest / Sleep in Last 24 Hours (hours)
Additional Comments or Notes
Submit Log
Should be Empty: