Select type of session (select all that apply). Answer remaining question based on session-type.



Program Review


Number of types selected:

General Client Programming
Number of Programs Observed (this is maxed at 5, as no more than this number should be targeted by in any specific session. Assess a max of 2 programs).

Program Observed:

Understands purpose of program

Program is individualized

Materials used/provided are relevant

Next steps have been identified

Program Observed:

Understand purpose of program

Program is individualized

Materials are relevant

Next steps have been identified

Client Programming Info
Delivery of client program info:
Answers staff questions
Openness to feedback from staff
Staff Feedback
Delivers feedback that is:

Select all solutions or training opportunities provided:

Provides description of skill(s)

Models required skill(s)

Allows practice w/feedback

Assigns activity

Schedules follow-up

Provides resource(s)

Communication Style
Data & Notes

Notes were completed during session

Notes were clear and easy to read

Notes focused on topics selected/discussed during session

Notes provided specific tasks


We have reviewed the results of the assessment.

Assessed Staff
Please note that this checklist is a hypothetical example and provides basic information only. It is not intended to take the place of, among other things, workplace, health and safety advice; medical advice, diagnosis, or treatment; or other applicable laws. You should also seek your own professional advice to determine if the use of such checklist is permissible in your workplace or jurisdiction.