Date	Time Began/ Time Ended	Location -Where were you?	Activity – What were you doing?	Strength of Urges (0-10)	Degree of Awareness (0-10)	Notable Feelings	Notable Thoughts	Notable Sensations	Site S-scalp B-Brows L-Lashes P-Pubic A-Arm L-Leg O-Other	Strength of Effort to Resist	Number Pulled/ Sites picked	Bleeding? Y/N	Tactics And Results	Comments