Evaluator
Assessment (partial)
MSM Session One – Fidelity of the Intervention
Date of session __
/ __ / __ Number of attendees ___ Number expected ___ ___
nEvaluator
Name _____________ Session Facilitator
Names_________________________
n
nEvaluation
of each component of the session:
nSession
goals and introductions (5 minutes):
Start Time: ___
: ___ AM/PM End Time: ___ : ___AM/PM Minutes ___ ___
Adherence to the manual: Excellent Good Fair
Poor
Quality of the content: Excellent Good Fair
Poor
Time Management:
Excellent Good Fair
Poor
Comments:
__________________________________________________________________
____________________________________________________________________________
nTechnical
difficulties (DVD, temperature, lights, snacks,
etc.):__________________________
____________________________________________________________________________
Recommendations for changing the content of the session:
_____________________________
____________________________________________________________________________
Recommendations for the facilitators:
____________________________________________
____________________________________________________________________________
Other:
_______________________________________________________________________