4 observation template

OMB 0915-XXXX, Expire XX/XX/2015

Session Title:

Type of session:

□ Keynote speaker □ Plenary session

□ Virtual breakout session □ Team report-out

Date:

Start time:

End time:

Observer/Notetaker:

Materials Distributed (Describe):

Were materials distributed before the session? □ Yes □ No

HRSA participants (Name, Title):

NICHQ participants (Name, Title)

HWC team participants (Name, Title):

Faculty participants (Name, Title):

Facilitators (Name):

Summary of Session Agenda (i.e. what is presented as the agenda, objectives, and topics for the session)

Was the agenda distributed before the session? □ Yes □ No

Summary Notes: (i.e. what happened, who talked about what, topics covered, messages provided, group activities)

Observed Interactions: (i.e. within teams, between teams, between teams and NICHQ presenters, between teams and facilitators; characteristics of teams – who seems on-board or bored? understands the concepts or confused? vocal or silent? making progress or not?)

Notetaker Impressions: (i.e., How well did the session meet its objectives? What activities, messages, materials, and processes seemed more effective, less effective? Why? What could have increased the effectiveness of the session? )

Ratings:

On a scale from 1 to 5, where 1 = low, 3 = medium and 5 = high, rate the overall level of effectiveness for the following topics: (A) logistics, (B) content, and (C) facilitation. Also provide a rating for each subtopic based on the assessment indictors detailed below.

A. Logistics
Assessment Indicators	Rating
No difficulties are experienced with meeting technology (i.e., logging in, audio quality, video quality). Meeting content is recorded. Meeting starts and ends on time Invited participants attend the meeting Meetings include ID of “action period” steps that participants can implement immediately Participants have sufficient content knowledge to contribute productively to meetings and action periods
B. Content
Assessment Indicators	Rating
Topics are important, relevant to participants, and focus on shared objectives Discussions are helpful and valued by participants Topics strike a balance between staying focused on LC agenda and following emerging topics of interest Facilitators demonstrate appropriate and sufficient content knowledge Subject matter experts are used as resources and participate as appropriate Information is shared clearly with an appropriate level of detail Slides and printed materials are informative and used effectively to guide discussion
C. Facilitation
Assessment Indicators	Rating
Speakers present information at a comfortable speed, and in a loud and clear voice All participants are given the opportunity to participate equally Flexible facilitators are able to respond to concerns of immediate importance Meeting provides opportunities to constructively problem solve issues Participants (facilitators, guest faculty, and state participants) are actively engaged Multi-directional interaction observed among participants Time is built in inside meeting or identified outside meeting for state teams to come together Effective use of Webinar technology to engage input as needed (e.g., electronic polling)

Summary of Ratings/Notetaker Impressions: Please clarify why you provided the ratings above for (A) logistics, (B) content, and (C) facilitation. Be sure to describe your impressions of the following: How well did the meeting go overall? How well did the meeting meet its objectives? Why? What could have increased the overall effectiveness of the meeting? [use additional pages as necessary]

Public Burden Statement: An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number. The OMB control number for this project is 0915-xxxx. Public reporting burden for this collection of information is estimated to average xx hours per response, including the time for reviewing instructions, searching existing data sources, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to HRSA Reports Clearance Officer, 5600 Fishers Lane, Room 10-29, Rockville, Maryland, 20857.