Warning:

This document is being maintained for historical purposes, but is now out of date. To view current guidelines please visit:

• HIV/AIDS Guidelines and Recommendations   at http://www.cdc.gov/hiv/guidelines/index.html

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Table_A3

                                                   Appendix C

                                               QUALITY ASSURANCE


                                  PROGRAM ASSESSMENT FORM - COMMUNITY EDUCATOR

       
       TOPIC: _______________________  EDUCATOR:______________________________
       
       GROUP (TYPE & SIZE): ______________________ REVIEWER: ____________________
       
       DATE: _____________TIME: _____________ PROGRAM LENGTH: ______________
       
       
       DIRECTIONS:  Check the appropriate columns to indicate degree to which the educator met
       performance criteria:
       
                    WELL - would indicate met criteria well.
       
                    ADEQUATELY - would indicate met criteria adequately.
       
                    NEEDS ATTN - needs attention and supervisory guidance to meet criteria.
       
                    N/A - would indicate this criteria did not apply to this situation.

Check only within and not between the boxes.  If undecided, use "comments" section to clarify.


                                                                                                                  NEEDS      
                                                                                         WELL     ADEQUATELY      ATTN     N/A
------------------------------------------------------------------------------------------------------------------------------ 
 INTRODUCTIONS
 
 1.    Introduces self by name and title.                                                                
 
 2.    Introduces others as appropriate.                                                                 
 
 3.    Clearly states purpose, goals, and objectives for session.                                        
 
 4.    Starts program at or within 10 minutes after starting time.                                       
 
 5.    Attends to participants' physical comfort.                                                        
       
       COMMENTS:

------------------------------------------------------------------------------------------------------------------------------ 
 CONTENT

 1.    Selects program content relevant to agency goals and audience needs.

 2.    Imparts factual information.                                                                      
 
 3.    Displays confidence in knowledge of material.                                                     
 
 4.    Provides background and supporting evidence to substantiate facts stated by 
       participants and by self.
 
 5.    Organizes activities and information in clear manner.                                             
       
       COMMENTS:

------------------------------------------------------------------------------------------------------------------------------ 
 PROFESSIONAL PRESENCE
 
 1.    Dresses in a manner that doesn't detract from aims of presentation.

 2.    Remembers and uses names of people, as appropriate.                                               
 
 3.    Is tactful when discussing controversial topics.                                                  
 
 4.    Imparts attitudes and information consistent with agency goals and policy.
 
 5.    Avoids careless use of slang words.                                                               
 
 6.    Uses grammatically correct english.                                                               
 
 7.    Handles unexpected or difficult questions with minimal display of 
       embarrassment or confusion.

 8.    Makes positive and tactful corrective statements.                                                 
 
 9.    Acknowledges contrary viewpoints.                                                                 
       
       COMMENTS:
 
------------------------------------------------------------------------------------------------------------------------------ 
 STRUCTURE
 
 1.    Focuses attention on topic with films, pre-test, or other motivational 
       techniques.

 2.    Selects teaching methods geared to audience and content (i.e., brainstorm, 
       lectures, etc.).
 
 3.    Selects teaching materials that enhance lesson plan.                                              
 
 4.    Allows sufficient time for activities.                                                            
 
 5.    Modifies teaching plan as indicated by audience response.                                         
 
 6.    Keeps session on track, sticks to the point.                                                      
 
 7.    Creates opportunities for questions, comments, clarifications, and expression 
       of opinions and feelings (elicits and pauses, etc.).

       COMMENTS:
 
------------------------------------------------------------------------------------------------------------------------------ 
 PROCESS SKILLS
 
 1.    Uses descriptive and reinforcing gestures.                                                         
 
 2.    Maintains eye contact with entire audience.                                                        
 
 3.    Adapts vocabulary level to understanding of group.                                                 
 
 4.    Enunciates and projects voice clearly.                                                             
 
 5.    Sets stage for activities and materials.                                                           
 
 6.    Explains materials used.                                                                           
 
 7.    Demonstrates knowledge and skill in operating a.v. Equipment.

 8.    Uses illustrative examples.                                                                        
 
 9.    Encourages all participants to be involved in activities.                                          
 
 10.   Avoids lags in flow of presentation.                                                               
 
 11.   Acknowledges and accepts statements of feelings and experiences of others.
 
 12.   Listens actively.                                                                                  
 
 13.   Affirms information accurately.                                                                    
 
 14.   Restates/clarifies/ emphasizes participants' comments and questions.

       COMMENTS:
 
------------------------------------------------------------------------------------------------------------------------------ 
 CONCLUSION
 
 1.    Summarizes major program points.                                                                   
 
 2.    Reviews program objectives before concluding.                                                      
 
 3.    Helps group identify further human or material resources.                                          
 
 4.    Remains available for individuals to approach them after the program.
 
 5.    Uses a tool to assess participants' satisfaction with program and program 
       impact.

       COMMENTS:
 
------------------------------------------------------------------------------------------------------------------------------ 

COMMENTS ON CONCLUSION:









AUDIENCE RESPONSE TO SPEAKER:










OVERALL SUGGESTIONS AND REMARKS:










SPEAKER'S COMMENTS AND SIGNATURE:

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