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To be completed at least twice a month, or at most once a week.

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* 1. Session Leader Name

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* 2. Date

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* 3. Unit & Lesson taught

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* 4. Percentage of students that received lesson

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* 5. Grade level

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* 6. At what time of day was the Positive Action lesson administered?

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* 7. Was the lesson adapted from the original plan and instructions?

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* 8. If Yes, how was the lesson adapted?

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* 9. Were there lesson specific posters in the classroom?

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* 10. Were activity sheets, booklets, or journals used in the lesson?

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* 11. Were there other items the lesson instructions called for that were used?

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* 12. Have you seen students applying concepts learned from past Positive Action materials?

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* 13. If Yes, in what ways have you noticed students applying Positive Action concepts?

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* 14. Between the past lesson and now, how often did you help students to understand that doing positive actions helps them feel good about themselves?

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* 15. Between the past lesson and now, how often did you recognize student’s positive actions in the classroom?

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* 16. Between the past lesson and now, how often did you reinforce students’ positive actions/behaviors when you observed them?

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* 17. Between the past lesson and now, how often did you encourage your students to do positive actions/behaviors outside the classroom?

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