Accelerometry Log - 6th Grade Students in Non-PYFP Schoo

EVALUATION OF THE PRESIDENTIAL YOUTH FITNESS PROGRAM

Att 31 Accelerometry Log

Accelerometry Log - 6th Grade Students in Non-PYFP School

OMB: 0920-1167

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Form Approved

OMB No. 0920-xxxx

Exp. Date xx/xx/xxxx












Accelerometry Log








Public reporting burden of this collection of information is estimated to average 30 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to CDC/ATSDR Reports Clearance Officer; 1600 Clifton Road NE, MS D-74, Atlanta, Georgia 30333; ATTN: PRA (0920-xxxx)








Meter Log

Wear the movement meter for seven (7) days in a row, including weekends. In the spaces below, write down the dates, days and times which you wear it. Please also write down the times school starts and ends each day. If you take the devices off for more than 30 minutes, such as for swimming, record when they were removed and for what reason. If you are unable to wear the meter for at least 12 hours one day, please wear it one extra day. Thank you!


Please start wearing your meter on or before ___________________________.

The last full day that your meter will work is ____________________!


Day 1

(Circle Day) Mon Tues Wed Thurs Fri Sat Sun Date______________

Time Meter Put On: am / pm Time school started: am / pm

Time Meter Taken Off: : am / pm Time school ended: am / pm

Shape3 Shape1 Shape2

Time removed during the day (e.g. 10:30-11am):

Why removed (e.g. swimming): ____________ ____________ ____________


Day 2

(Circle Day) Mon Tues Wed Thurs Fri Sat Sun Date______________

Time Meter Put On: am / pm Time school started: am / pm

Time Meter Taken Off: : am / pm Time school ended: am / pm

Shape6 Shape4 Shape5

Time removed during the day (e.g. 10:30-11am):

Why removed (e.g. swimming): ____________ ____________ ____________


Day 3

(Circle Day) Mon Tues Wed Thurs Fri Sat Sun Date______________

Time Meter Put On: am / pm Time school started: am / pm

Time Meter Taken Off: : am / pm Time school ended: am / pm

Shape9 Shape7 Shape8

Time removed during the day (e.g. 10:30-11am):

Why removed (e.g. swimming): ____________ ____________ ____________

Day 4

(Circle Day) Mon Tues Wed Thurs Fri Sat Sun Date______________

Time Meter Put On: am / pm Time school started: am / pm

Time Meter Taken Off: : am / pm Time school ended: am / pm

Shape12 Shape10 Shape11

Time removed during the day (e.g. 10:30-11am):

Why removed (e.g. swimming): ____________ ____________ ____________

Day 5

(Circle Day) Mon Tues Wed Thurs Fri Sat Sun Date______________

Time Meter Put On: am / pm Time school started: am / pm

Time Meter Taken Off: : am / pm Time school ended: am / pm

Shape15 Shape13 Shape14

Time removed during the day (e.g. 10:30-11am):

Why removed (e.g. swimming): ____________ ____________ ____________


Day 6

(Circle Day) Mon Tues Wed Thurs Fri Sat Sun Date______________

Time Meter Put On: am / pm Time school started: am / pm

Time Meter Taken Off: : am / pm Time school started: am / pm

Shape18 Shape16 Shape17

Time removed during the day (e.g. 10:30-11am):

Why removed (e.g. swimming): ____________ ____________ ____________


Day 7

(Circle Day) Mon Tues Wed Thurs Fri Sat Sun Date______________

Time Meter Put On: am / pm Time school started: am / pm

Time Meter Taken Off: : am / pm Time school ended: am / pm

Shape21 Shape19 Shape20

Time removed during the day (e.g. 10:30-11am):

Why removed (e.g. swimming): ____________ ____________ ____________



Day 8 (if needed)

(Circle Day) Mon Tues Wed Thurs Fri Sat Sun Date______________

Time Meter Put On: am / pm Time school started: am / pm

Time Meter Taken Off: : am / pm Time school started: am / pm

Shape24 Shape22 Shape23

Time removed during the day (e.g. 10:30-11am):

Why removed (e.g. swimming): ____________ ____________ ____________



FOR OFFICE USE ONLY


Participant ID __________________

Recruiter __________________

Meter Number __________________


Date Initialized: __________________

Valid meter days: __________________

First Mail Day: __________________

You’re done! Please include this log in your return envelope along with the meter and belt.




File Typeapplication/vnd.openxmlformats-officedocument.wordprocessingml.document
File TitleMeter and GPS Log
Authorcfranklin
File Modified0000-00-00
File Created2021-01-23

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