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HeartsNParks Community Mobilization Guide - National Heart, Lung ...

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PROGRAM DESIGN & DEVELOPMENT<br />

Tracking Sheet<br />

Use this tracking sheet to record information about each one of the <strong>Heart</strong>s N’ Parks programs<br />

that uses performance indicators.<br />

Site Name<br />

and Location: _______________________________________________________________________<br />

Program<br />

Name: _____________________________________________________________________________<br />

If you are running multiple programs under a common name, please specify which one this is:<br />

_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _<br />

1. Number of participants at start of program: ____________ Start Date: _______________<br />

2. Number of participants at completion: ____________ Completion Date: _____________<br />

3. Total length of program (in weeks and days): ____________<br />

Names and Date(s) of Pretest:__________________________________________________________<br />

__________________________________________________________________________________<br />

__________________________________________________________________________________<br />

Names and Date(s) of Posttest:_________________________________________________________<br />

___________________________________________________________________________________<br />

___________________________________________________________________________________<br />

4. How many days per week did your program run? ____________<br />

5. How many hours per day did it run on average? ____________<br />

A-3<br />

A-1

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