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Media Diet Worksheet
Media Diet Worksheet
Name
*
First
Last Name
*
Last
Email
*
Date of Media Intake
*
How much time was spent on this one activity?
*
Report the time first by hour(s) and then minutes in decimals ie. 2.25 for two hours and fifteen minutes.
What technology device did you use?
*
SmartPhone
Television
Radio
Desktop Computer
Tablet / iPad
Didn't find the technology?
Did you access a social media platform?
*
Discord
Facebook
Instagram
Reddit
Snapchat
TikTok
Twitter
WhatApp
N/A
Didn't find the app?
What label best describes this activity?
*
Digital Assist (Alexa, Siri, Google Maps)
Audio Broadcast Streaming (Spotify, iTunes)
Engagement (eBooks, Podcasts)
Gaming ("Angry Birds" to "League of Legends")
Short Film & Video (YouTube, Vimeo)
Television Network & Cable News and Shows (NBC, ESPN)
Video Streaming Services (Hulu, Netflix)
Work & Career (Excel, Sprout.io, Canvas)
Didn't find the activity listed?
How satisfied were you with this reported technology experience?
*
1 (worst)
2
3
4
5 (best)
Technology - WiFi access and strength, adequate device for the task
*
1 (worst)
2
3
4
5 (best)
Connection - were you able to communicate successfully as a sender and receiver
*
1 (worst)
2
3
4
5 (best)
Happiness - did this activity provide you with feelings of joy, peace, connection with community, or sense of wellbeing?
*
1 (worst)
2
3
4
5 (best)
Action - did you complete a task or achieve a goal with this activity?
*
1 (worst)
2
3
4
5 (best)
OVERALL SATISFACTION - how do you feel about the time spent engaged with this activity?
*
1 (worst)
2
3
4
5 (best)
Description / Information
For instance, were you watching the Padres play Colorado or playing League of Legends online with new friends in Germany.
If you are human, leave this field blank.
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