Zones Regulation Check In SheetDaily Zones Check-In Counselor & Student Regulation Log Name: Date: Time: 1 Which Zone are you in right now? (Check the box that matches your feeling) Blue Zone 🌧️ Low Energy Sad • Tired • Sick • Moving Slowly Green Zone 🌱 Ready to Learn Calm • Focused • Happy • In Control Yellow Zone ⚡ High Energy Worried • Silly • Frustrated • Excited Red Zone 🌋 Out of Control Angry • Panicked • Yelling • Overwhelmed 2 What is your body feeling? (Body Signals) Select all clues your body is giving you: 🧠 Head & Face Heavy eyelids Hot / red face Clenched teeth/jaw 🫀 Heart & Chest Steady & calm heart Fast / pounding heart Holding breath / fast 🖐️ Hands & Tummy Tight / balling fists Butterflies / tight gut Fidgety / sweaty hands ⚡ Full Body Slumping / tired body Bouncing / tapping feet Muscle tension / rigid 3 Intensity Meter (Scale 1 – 5) How strong is this feeling inside you? 1 Very Low Barely feel it / sleepy 2 Mild / Easy Smooth & steady 3 Medium Starting to bubble up 4 Strong Hard to ignore / rising 5 Extreme Overflowing / need help 4 My Regulation Tool (Choose 1 or 2 tools) What will help support your body right now? 🌬️ Deep Breathing 5-finger or box breath 🧸 Sensory Tool Fidget, putty, or weight 🚶 Movement Break Wall push, walk, stretch 💧 Cold Water & Snack Hydrate & reset mouth 🎨 Quiet Focus Doodle, write, listen music 💬 Talk & Problem-Solve Counselor or safe person 5 Check-Out: After using my tool, my Zone is now: Blue Green Yellow Red My next goal for class: