Health Blueprint Worksheet
6th Grade Health & Wellness
My Personal Health Blueprint
Self-Management • Daily Habits • Safety
Name:
Date:
Period:
Part 1
The Daily Four Health Audit
Middle school recommended standards
1. Sleep Hygiene
Target: 9-11 hrs
Average hours I slept last night:
Morning Energy:
Low Moderate Energized
2. Hydration
Target: 6-8 cups
Track typical water intake (shade cups):
3. Balanced Fuel
Rainbow Plate
Healthy foods eaten today:
Fruits Veggies Protein
4. Daily Movement
Target: 60+ mins
Primary physical activity today:
Habit Reflection: Which habit above is your strongest strength right now, and which one needs the most attention? Explain why.
Part 2
Personal Safety & Everyday Choices
Self-management in real life
Scenario A: Screen Time & Sensory Protection
Jordan listens to music on earbuds at 95% volume while gaming for 4 hours without taking any eye or ear breaks.
Health risk of this choice:
Safer self-management strategy:
Scenario B: Injury Prevention & Body Signals
Alex is riding a scooter to practice on a hot 88°F afternoon without a helmet or water bottle, and feels a sharp ankle twinge during warmup.
Two physical safety oversights:
What Alex should do immediately:
Unit: Physical Health & Personal Responsibility Page 1 of 2
Action Planning
My Health Goal Blueprint
SMART Action Steps • Habit Mastery
Self-management means turning health knowledge into daily practice. Choose one specific habit area from Page 1 to elevate over the next two weeks.
Step 1
Select Your Primary Health Focus
Consistent Sleep Hydration Boost Daily Movement Safety & Tech Care
Step 2
Draft Your Specific Goal
Clear, realistic, measurable
Prompt: "For the next two weeks, I will..." (include what, when, and how much)
Step 3
My Motivation: Why This Matters to My Body & Mind
How will achieving this goal help you feel, perform in school, or stay energized?
Step 4
My 3 Action Steps (Micro-Habits)
The "If-Then" Obstacle Buster
IF this obstacle pops up (e.g., tired, distracted):
THEN I will overcome it by:
Weekly Habit Check-In Grid
Put a checkmark or initials each day you practice your goal
MON
TUE
WED
THU
FRI
SAT
SUN
Student Signature:
Accountability Partner:
Unit: Physical Health & Personal Responsibility Page 2 of 2