About This Worksheet
Evaluate how screen time timing and duration affect your child's ability to fall asleep and stay asleep.
This worksheet helps you organize and calculate the key information for screen time sleep impact assessment. Fill in each section carefully. Use the calculation areas to verify your numbers before transferring them to the official form.
How to Complete This Worksheet
- Print this worksheet or use it on screen.
- Complete each section in order.
- Use a calculator for all math. Do not estimate.
- Double-check every calculation before moving to the next section.
- Transfer final figures to your official form when complete.
- Keep this worksheet with your records.
Screen Time Sleep Calculations
Enter your figures for screen time sleep impact assessment below. Pull numbers from official documents, not estimates.
Screen Time and Sleep Impact Assessment
| A. | Total hours of nighttime sleep (from bedtime to morning wake, minus wakings) | hrs ________ |
| B. | Number of night wakings | # ________ |
| C. | Total minutes awake during night wakings | min ________ |
| D. | Nap 1 duration | min ________ |
| E. | Nap 2 duration | min ________ |
| F. | Nap 3 duration (if applicable) | min ________ |
| G. | Total daytime sleep (D + E + F) | min ________ |
| H. | Total 24-hour sleep (A + G converted to hours) | hrs ________ |
| I. | Longest stretch of uninterrupted night sleep | hrs ________ |
Your Information
Enter your details as they appear on your official documents.
As it appears on your government ID.
Today's date, MM/DD/YYYY.
From prior screen time sleep impact assessment filings. Write N/A if none.
Additional Notes
Record any other information relevant to your screen time sleep impact assessment calculations.
Verification
Before transferring figures to your official form, confirm:
- All figures are accurate and match your source documents.
- All calculations have been double-checked with a calculator.
- Names and dates match your official identification.
- Information is consistent with requirements for screen time sleep impact assessment.