Leader Self-Evaluation Form BCBH Workshop Leader Self-Evaluation Fidelity Tool Program fidelity refers to the how closely we follow the program design. Self-evaluation and regular de-briefing between co-leaders are important to make sure the workshop experience is the highest quality. The areas below are intended to serve as a guide for de-briefing with your co-leader as well as a self-evaluation. Name*First & Last Phone*Email* Co-Leader* Workshop InformationWorkshop CurriculumCDSMP? CDSMP CDSMP CDSMP Live! (Virtual) CDSMP @ Home (Toolkit with Weekly Leader Calls) CDSMP (In-person *prior approval required*) TDS? Tomando Control de su Salud Tomando Control de su Salud Tomando Control de su Salud Live! (Virtual) Tomando Control de su Salud (In-person *prior approval required*) DSMP? DSMP DSMP DSMP Live! (Virtual) DSMP @ Home (Toolkit with Weekly Leader Calls) DSMP (In-person *prior approval required*) CPSMP? CPSMP CPSMP CPSMP Live! (Virtual) CPSMP @ Home (Toolkit with Weekly Leader Calls) CPSMP (In-person *prior approval required*) CTS? CTS CTS CTS Live! (Virtual) CTS (In-person *prior approval required*) wCDSMP? wCDSMP wCDSMP wCDSMP Live! (Virtual) wCDSMP (In-person *prior approval required*) WWE? WWE WWE Take A Step & Walk With Ease (Virtual) Walk With Ease (In-person) F&S? F&S F&S Fit & Strong @ Home (Virtual) Fit & Strong! (In-person) In-person Workshops:City State Facility Name Please provide at least 1 comment for each of the 4 sections General1. Debriefing with each other is necessary after each workshop session (or between sessions) to plan for the next session and address any issues. What things did you and your co-leader work on?2. Were there any problems/difficult situations that occurred during the workshop? (with participants, the site, virtual platform, conference call service, etc.) Yes No Please explain:3. Do you think you would want a refresher course before you lead your next workshop? Yes No Please explain:Fidelity4. Did you have any specific concerns with maintaining program fidelity before, during, or after the workshop sessions? Yes No Please explain:5. Were there any concerns regarding the site, virtual delivery platform, or conference call service that prevented participants from attending? Yes No Please explain:6. Timeline/agenda were followed for: start time, end time, breaks, followed activities and session time limits. Yes No If No, explain:7. Were there any concerns about privacy and confidentiality? Yes No Please explain:8. Confirm: I did not add content not included in the manual and did not skip or leave out material from the manual. Yes No If No, explain:Facilitation9. I was respectful and non-judgmental to participants. Yes No If No, explain:10. I provided information, rather than told what to do. Yes No If No, explain:11. I kept participants on topic. Yes No If No, explain:12. I gently encouraged, rather than forced participation. Yes No If No, explain:13. I managed group dynamics calmly and effectively. Yes No If No, explain:14. I modeled Introductions, Action Planning, Feedback, and Problem Solving as indicated in the manual. Yes No If No, explain:15. I followed Brainstorming Guidelines as instructed in the manual. Yes No If No, explain:Modeling16. I maintained good eye contact with the group. Yes No If No, explain:17. I spoke loud enough for all to hear. Yes No If No, explain:18. My body language demonstrated I was present and engaged. Yes No If No, explain:19. My co-leader and I worked well together, assisting each other as needed. Yes No If No, explain:Workshop Feedback20. On a scale of 0-10, with 10 being most satisfied, how satisfied were you with how the workshop went overall?(Ex. participant engagement/discussion, participant attendance, your performance as a facilitator, room feel) 0 1 2 3 4 5 6 7 8 9 10 21. What challenges or barriers did you experience? How did you manage them?22. Please share any participant or leader experiences, stories, or testimonials from this workshop that could be used to inspire others to participate (attend a workshop, become a leader, as a host site, etc.).23. Other thoughts:HiddenCAPTCHAEmailThis field is for validation purposes and should be left unchanged.