Republic of the Philippines

Department of Education
REGION VI – WESTERN VISAYAS
DIVISION OF NEGROS OCCIDENTAL

Name: ___________________________________ Date: ________________________

Position: _________________________ Office/School: ________________
Age:_______ Sex:___________ Religion:_____________________

Health and Wellness Plan

A. Weight
Present Weight (kgs):__________ Weight Goal in the next 6 Months:___________

Action Plan:

B. Blood Pressure
Present Blood Pressure: _______Blood Pressure Goal in the next 6 months: ______

Action Plan:
C. Healthy Eating
Specific things I want to do to improve my eating habits.

Action Plan:

D. Physical Activities
Present Ave. No. of hours per day of physical activity: ____________________
Goal Ave. No. of hours per day of physical activity: ______________________
Kinds of Activities: ____________________________________________________

Action Plan:

E. Stress and Coping

Ways I can improve mental and emotional health and coping skills.

Action Plan:
F. Spiritual Health
Values, Virtues, and Service to others I would like to incorporate into my life that
would provide meaning, purpose, peace, , and enrichment to my life and to
others.

Action Plan: