Overview

Purpose: The purpose of the Health Check Report Card is to help individuals keep track of their eating and physical activity behaviors. Specifically the Health Check Report Card helps to reduce factors related to cardiovascular disease risk by:

  • decreasing the intake of fat, sodium, and sugar
  • increasing intake of fruits, vegetables, and calcium
  • increasing physical activity

This tool is not meant to be used as a diet plan. Please consult your physician before beginning a physical activity regiment.

 

Instructions for Completing and Accessing the Health Check Report Card:

How to Access:

In order to access the Health Check Report Card, please complete the enrollment survey found below. At the end of the survey you will be provided with a link where you will be able to download and print this tool.

http://www.surveymonkey.com/s/T59LLN9

 

How to Complete:

Please complete the Health Check Report Card every day. Each card can be used for 1 week. Use the Go, Slow/Stop, and Fruit and Vegetable lists to help you complete the report card. Each food is worth 1 point.

 

Foods are broken down into three categories

  1. Go Foods – foods low in sugar, sodium, and fat and are high in calcium
  2. Slow/Stop Foods – foods that are high in sugar, sodium and fat
  3. Fruits and Vegetables

A point should be placed for each serving of a food on the Go Food list or a food that is prepared in a way that makes it lower in sugar, sodium, or fat in that day’s Go Food row.

A point should be placed for each serving of a food on the Slow/Stop Food list or a food that is prepared in a way that makes it high in sugar, sodium, or fat, in that day’s Slow/Stop row.

A point should be placed for each fruit and vegetable serving in that day’s Fruit and Vegetable row.

 

For Physical Activity, place a number of points from 2-10 corresponding to the amount of time you spend being physically active.

  1. 2 points = Less than 15 minutes a day
  2. 4 points = 15 – 29 minutes a day
  3. 6 points = 30 – 44 minutes a day
  4. 8 points = 45 – 59 minutes a day
  5. 10 points – 60 or more minutes a day

 

At the end of the week, add the numbers in every category for each day and place the number in the “weekly total” box. If you have reached your goal for a particular category, place a checkmark in the “I reached my goal” box.