Activity

Initial Date

Do you have pain with activity? If yes, where? rate pain from 1 - 10 using VAS provided below.

Follow Up

(4 weeks)

Date:

1) Cutting deli meat on slicer

2) Reaching for meat/cheese and placing on slicer

3) Shaking salt, pepper, etc

4) Squeezing oil, vinegar, etc,

5) Cut Sandwich

6) Wrapping Sandwich

7) Placing deli meat/cheese on sandwich

8) Using cash register

9) Chop Cheesesteaks on Grill

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