Start Time:
End Time

School Personnel Involved

Site Visit Review Items for the Month

Site Visit Review Items

Comments and Documentation

Other Items Discussed

Stakeholder Data to be Collected

Stakeholder Interviews

Technical Assistance Provided

Areas of Strength

Areas of Improvement Identified This Month

Area of Improvement

Action Steps Required

Timeframe for Completetion

Follow- Up on Previously Identified Areas for Improvement

Area for Improvement

Progress of Required Action Steps

Timeframe for Completion

Improvement Progress
Summary of Findings

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.