Program Fidelity Monitoring Form
Use this form to document a program fidelity review, record observations, rate implementation quality, and note follow-up actions.
Program Details
Program or Initiative Name
*
Site / Location
*
Monitoring Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Monitoring Context
Monitor Name
*
Role / Title
*
Monitoring Type
*
On-site
Virtual
Record Review
Observation
Fidelity Review
Fidelity standard or protocol version
*
Overall fidelity rating
*
Needs Improvement
1
2
3
Excellent
4
1 is Needs Improvement, 4 is Excellent
Key strengths observed
*
Implementation gaps or barriers
*
Follow-up actions / support needed
*
Submit Program Fidelity Monitoring Form
Should be Empty: