Healthy Lifestyle Checklist Form
Use this checklist to reflect on your daily healthy habits and track your progress towards a balanced lifestyle.
Which of these physical activities did you complete today?
Walked at least 30 minutes
Completed a workout or exercise session
Stretched or did yoga
Took the stairs instead of the elevator
Other
Which healthy eating habits did you practice today?
Ate at least 5 servings of fruits and vegetables
Chose whole grains over refined grains
Limited processed foods and added sugars
Prepared a healthy home-cooked meal
Other
How much water did you drink today?
Less than 4 cups
4-7 cups
8 or more cups
How many hours did you sleep last night?
Less than 6 hours
6-7 hours
8 or more hours
Did you take time to manage stress or practice mindfulness today?
Yes
No
Which self-care activities did you do today?
Spent time outdoors
Read, listened to music, or enjoyed a hobby
Connected with friends or family
Took a break from screens
Other
Did you avoid smoking or excessive alcohol consumption today?
Yes
No
Not applicable
How would you rate your overall mood today?
1
2
3
4
5
Do you have any comments or notes about your healthy lifestyle today?
Submit Checklist
Should be Empty: