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Directions: Complete this survey to assess the level with which you are implementing the Prevention Plus Wellness program with fidelity.  All "yes" responses = complete fidelity.

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* 1. Today's date:

Date

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* 2. Prevention Plus Wellness program(s) implemented?

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* 3. Code number:

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* 4. Did implementers complete a Prevention Plus Wellness (PPW) Program Implementer Training Workshop within the last 3 years?

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* 5. Did implementers practice the PPW Lesson Script(s) at least 3 times prior to implementing the program?

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* 6. Did you implement the PPW Health Behavior Survey pretest before implementing the program and posttest 1-3 months after the program each time?

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* 7. Did you implement the PPW lesson following the script each time?

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* 8. Did you provide the script content with enthusiasm and passion each time?

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* 9. Did you provide the screening survey, feedback lesson script and goal plan all in one session each time?

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* 10. Did you show the PPW program PowerPoint slides during the lesson each time?

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* 11. Did you read the entire goal plan and help participants complete it each time you implemented the program?

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* 12. Did you have participants sign the goal plan and did you co-sign the goal plan every time you implemented the program?

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* 13. Did you implement the PPW Posttest Survey 1-2 times after implementing the lesson each time?

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* 14. Did implementers complete an Instructor's Survey assessing your presentation quality after implementing each PPW lesson?

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* 15. Did you remind participants to post their goal plan where they would see it and monitor their goals daily as well as set new goals each week every time you implemented the program?

0 of 15 answered