A sensory diet template that schedules OT-chosen activities by time of day, with a sample schedule, checklist and response log.
✓Schedule by time of day
✓Carer checklist and response log
✓Plan ahead for hard events
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What's inside
About This Plan
Daily Activity Schedule
Sensory Diet Checklist
Calming and Helpful Spaces
Before Difficult Times
Response Log
Notes for School or Other Carers
Questions for the Therapist
Preview · 8 sections
Sensory Diet and Activity Schedule
Child
Date started
Occupational therapist
Review date
Main carers
School or centre
About This Plan
What this plan is helping with, in everyday words
Signs the child may need a break, as the family describes them
Daily Activity Schedule
Time of Day
Activity (chosen by the OT)
Purpose, in the Child's Words or Parent's Observation
How Long
How the Child Responded
On waking
Before leaving for school
At school (if agreed with the teacher)
After school
Before homework
Before bed
Sensory Diet Checklist
☐ This activity is on the plan agreed with the occupational therapist
☐ The child was offered a choice and agreed
☐ The space is clear and safe
☐ An adult is nearby for movement activities
☐ The child's response was noted in the log
Calming and Helpful Spaces
Where the child can go at home and at school, and what is in that space
Before Difficult Times
Situation
Activity to Try First
Who Helps
Response Log
Date
Activity and Time
What We Noticed Before
What We Noticed After
Child's Own Words
Notes for School or Other Carers
What a teacher, grandparent, or helper needs to know
Questions for the Therapist
Questions and observations between sessions
How to fill it in
1
About This Plan
What the plan helps with, and the child's signs of needing a break.
More guidance
In everyday words, write what the plan is helping with and the signs that the child may need a break, as the family describes them. Use the child's own words where they have them. A new teacher or relative should understand the plan after reading this section for a minute.
2
Daily Activity Schedule
Each OT-chosen activity by time of day, its purpose, length and the child's response.
More guidance
For each time of day, write the activity the OT has chosen, its purpose in the child's or parent's words, how long it lasts and how the child responded. Describe the purpose by what the family has noticed rather than by what the activity is supposed to do. Fill in the response column closely for the first weeks so the OT can review it.
3
Sensory Diet Checklist
Basic checks before any activity, plus items specific to this child.
More guidance
Run through the checklist when the plan is reviewed and whenever someone new starts using it. It covers the basics for any activity: it is on the OT's plan, the child has a choice, the space is safe, an adult is nearby, and the response is logged. Add items specific to this child.
4
Calming and Helpful Spaces
Where the child can calm down at home and school, and what is there.
More guidance
Describe where the child can go to calm down at home and at school and what is in that space. Keep it practical for small homes and crowded classrooms: a corner with a cushion, a space under the stairs, the library corner. Note who at school has agreed to the space.
5
Before Difficult Times
Known hard events, the first activity to try, and who helps.
More guidance
List known hard situations, the activity to try first and who helps. Plan with the family for events in their own life, such as festivals, haircuts, family functions, long bus rides or exams. Keep each plan short enough to remember in the moment.
6
Response Log
Date, activity, what you noticed before and after, and the child's words.
More guidance
Record the date, the activity and time, what you noticed before and after, and anything the child said. Keep notes short and factual. The OT uses this log to decide what to keep, change or stop, so honest notes about refusals and bad days help as much as notes about good ones.
7
Notes for School or Other Carers
What a teacher or other carer should do, avoid, and how to reach the family.
More guidance
In a few lines, write what a teacher, shadow teacher, grandparent or helper needs to know: what to do, what to avoid and how to reach the family. Share the plan beyond the family only with their consent.
8
Questions for the Therapist
Questions and observations between sessions, reviewed at each visit.
More guidance
Leave space for the family and school to note questions and observations between sessions, and go through them at each visit.
Sensory diet template and sample schedule: filled sample
Fictional entries, initials only, showing the level of detail to aim for. Impression and summary sections are left for the treating clinician.
About This Plan
This plan helps M. through the school morning and into homework. Signs she needs a break: humming loudly, chewing her collar, saying 'too much'.
Daily Activity Schedule
Before homework: 5 minutes of animal walks along the corridor (chosen by OT). Purpose, in mother's words: 'She sits down more easily after moving.' Response: Mon sat for 15 minutes; Wed refused, tired.
Sensory Diet Checklist
Added for M.: check she has eaten something before movement activities after school.
Calming and Helpful Spaces
Home: corner of the bedroom with a floor mattress and her blue blanket. School: library corner, agreed with the class teacher, with a 5-minute sand timer.
Before Difficult Times
Haircut on Sunday: before leaving, 10 minutes of carrying shopping bags with father (chosen by OT); take ear defenders; father holds her hand at the salon.
Response Log
12 Aug, after school, wall push-ups for 2 minutes. Before: crying, threw her bag. After: drank water, sat with grandmother. M. said: 'Arms tired. Okay now.'
Notes for School or Other Carers
If M. starts humming loudly in class, let her walk to the corridor water tap and back. Please do not use these activities as a reward or take them away as a punishment.
Questions for the Therapist
She asks for the swing at the park every evening now. Should we add it to the plan?
Sensory diet vs OT home programme
Sensory diet
OT home programme
Focus
Sensory and movement activities spread through the day
Practice toward wider goals such as dressing and hand skills
Organised by
Time of day
Daily routine
Records
How the child responded, before and after
Whether the activity was done and how it went
Activities chosen by
The occupational therapist
The occupational therapist
How often it changes
Often in the first weeks, as responses are reviewed
Every few weeks, as goals progress
Tips and mistakes to avoid
Do
Keep the schedule short; a few activities are easier than a full timetable.
Build activities into chores like carrying shopping bags or kneading chapati dough.
Agree school activities with the class teacher before writing them in.
Ask families to log refusals and hard days too.
Describe it to families as a plan to try and review together, and avoid presenting it as a fix for behaviour.
Avoid
Copying a generic activity list instead of the OT's choices for this child.
Adding movement or pressure activities without the therapist's advice.
Using sensory activities as rewards, or withholding them as punishment.
Writing purposes as claimed effects, such as 'to fix attention'.
About this home programme
A sensory diet template is a daily schedule of sensory activities chosen by the child's occupational therapist, set out by time of day with how long each lasts and how the child responded. This free sensory diet template includes the schedule, a sensory diet checklist for carers, a plan for difficult times and a response log.
The OT recommends planned sensory activities through the day
School and family need the same activities
Before a hard event like a haircut or wedding
At review, to adjust the plan
Read more
A sensory diet is a planned set of sensory and movement activities through a child's day, also called a sensory activity schedule. The child's OT selects the activities and changes them as responses are reviewed.
This is the written plan families and teachers follow, with a log so the therapist can see what happened. It helps you plan, record and review, and makes no promise about results.
Questions
What is a sensory diet?+
A planned set of sensory and movement activities through a child's day, chosen by an occupational therapist after assessment and changed as the child responds. It is one possible support within a wider OT plan.
Who should create a sensory diet?+
The child's occupational therapist, working with the family and, where relevant, the school. This template records the activities the OT has chosen; it does not suggest activities itself.
What should a sensory diet checklist include?+
Basic checks before each activity: it is on the OT's plan, the child was offered a choice, the space is safe, an adult is nearby for movement, and the response is logged.
How do we know if the sensory diet is helping?+
Use the response log. Note what you saw before and after each activity and share it with the OT, who decides what to keep, change or stop.
Is there a sample sensory diet on this page?+
Yes. Each section guide shows a fictional sample entry, initials only, marked as chosen by the OT. Do not copy the sample activities; use only those your child's therapist has chosen.
Can teachers use this sensory diet template at school?+
Yes, if the family consents and the teacher agrees which activities fit the classroom. The notes section is written for school staff and other carers.
Can I download a sensory diet template PDF?+
Yes. Fill it in online with no sign-up and download a PDF, or print it blank. Drafts stay in your browser.
