Adherance Chart – Action Steps

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ADHEARANCE CHART: ACTION STEPS
NAME:
START DATE:
What action steps are you taking this month? (List as many as you have committed to do)
Example: This month I will reduce my normal intake of fizzy drinks by 50%
1.
2.
3.
4.
In the box below put a “1” on the days where you have achieved your action steps and a “0” on the days where you did not.
Action Step 1
Action Step 2
Action Step 3
0
1
1
NA
Weekly Total
/7
/7
/7
/7
Weekly Total
/7
/7
/7
/7
Weekly Total
/7
/7
/7
/7
Example
Action Step 4
Day 1
Day 2
Day 3
Day 4
Day 5
Day 6
Day 7
Day 8
Day 9
Day 10
Day 11
Day 12
Day 13
Day 14
Day 15
Day 16
Day 17
Day 18
Day 19
Day 20
Day 21
Day 22
Day 23
Day 24
Day 25
Day 26
Day 27
Day 28
E-Mail: [email protected] Web: www.theresultsroom.com.au
Phone: 07 31615361 Mob: 04415035407
ADHEARANCE CHART: ACTION STEPS
Weekly Total
/7
/7
/7
/7
Over all Total
/28
/28
/28
/28
A score over 22 is fantastic and means you are on the way to creating a new habit, 21 and below just means you need to adjust your action steps
so they are more acheiveable.
E-Mail: [email protected] Web: www.theresultsroom.com.au
Phone: 07 31615361 Mob: 04415035407
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