Activity Leader Evaluation Form

Group Leader Evaluation

Title of Program:

Date:

Number in Attendance:

Describe in your own words, the purpose or the expected outcome of 
this program?



A. NA   1   2   3   4   5  Leader is appropriately dress for the activity
B.	NA   1   2   3   4   5	Positive attitude maintained

C.	NA   1   2   3   4   5	Leader checks in with each client 

D.	NA   1   2   3   4   5	Pt's tx goals/objectives are tied in 
				            with program objectives and the pt				
				            is given opportunity to understand 
				            reasons for this program/activity

E.	NA   1   2   3   4   5	Leader is well prepared for this group 
				            session. Started on time.					
				            Materials/props were available as needed.

F.	NA   1   2   3   4   5	Reality Orientation, sensory stimulation, 
				            remotivation, and/or other therapeutic 
				            techniques were was utilized as appropriate

G.	NA   1   2   3   4   5	Leader demonstrated creativity in 
				            approaches to group dynamics and in 
				            presentation of the activity.

H.	NA   1   2   3   4   5	Directions, objectives, & other info
				            were provided in a clear manner. 

I.	NA   1   2   3   4   5	Leader helped maintain direction of the
				            group's objectives.

J.	NA   1   2   3   4   5	Leader helped rephrase confusing thoughts,
				            summarized complicated thinking, or 
				            analyzed & summarized viewpoints of others.

K.	NA   1   2   3   4   5	Leader encouraged involvement and was 
				            attuned to each client's readiness level 
				            or strength.

L.	NA   1   2   3   4   5	Leader was flexible and able to change 
				            plans based upon group reactions.

M.	NA   1   2   3   4   5	Leader maintained composure through 
				            difficult situations.

N.	NA   1   2   3   4   5	Leader effectively resolved conflicts.

O.	NA   1   2   3   4   5	Patient Satisfaction Level: were 
				            participants satisfied with the outcome 
				            of the group?

P.	NA   1   2   3   4   5	Process: was the clients given opportunity
				            to process what they learned, their 
				            thoughts, &/or their feelings

Q.	NA   1   2   3   4   5	Ending: did the program end when it was 
				            supposed to? With a summary? With a word 
				            of thanks? For them to come back? With
				            recognition?


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