HealthFill-in Worksheet

Time Zone Change Sleep Adjustment Worksheet

Plan gradual schedule shifts for your child when crossing multiple time zones during travel.

2 min read
In This Guide

About This Worksheet

Plan gradual schedule shifts for your child when crossing multiple time zones during travel.

This worksheet helps you organize and calculate the key information for time zone change sleep adjustment. 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

  1. Print this worksheet or use it on screen.
  2. Complete each section in order.
  3. Use a calculator for all math. Do not estimate.
  4. Double-check every calculation before moving to the next section.
  5. Transfer final figures to your official form when complete.
  6. Keep this worksheet with your records.
Pro Tip: Call the processing office to confirm your submission was received if you have not gotten acknowledgment after 2 weeks.

Time Zone Change Calculations

Enter your figures for time zone change sleep adjustment below. Pull numbers from official documents, not estimates.

Time Zone Change Sleep Adjustment Worksheet

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 time zone change sleep adjustment filings. Write N/A if none.

Additional Notes

Record any other information relevant to your time zone change sleep adjustment 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 time zone change sleep adjustment.
Prepared by: _________________ Date: _________________
Important: Transfer these figures to the official form only after verifying all calculations. Errors caught here are easy to fix. Errors on the submitted form cause delays.

Disclaimer: SleepCoach is a wellness app, not a medical device. Consult your pediatrician for medical sleep concerns. Results vary by child and family.

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