Docstoc

Training Participant Feedback Form - Excel

Document Sample
Training Participant Feedback Form - Excel Powered By Docstoc
					                                                                                                AAHT - SIYAFUNDISA PROGRAMME                                         Form ___ of ____
                                                                                                  Session Attendance Register

                                                                                    *Sumbit for collation by first the Sunday following the last session recorded on the form
                                                        Session Summary Information
1. Peer Educator Names or                                                                                                                          4. Target Age Group                10 - 13 Yrs                          19 - 24 Yrs
     Life Skills Facilitator Names:                                                                                                                 (select only one):                14 - 18 Yrs                          Adults
                                                                                                                                                   5. Siyafundisa Programme:          Peer Education                       Life Skills
                                                                                                                                                    (select only one):                  Site Details
                                                                                                                                                   6. Site Name:
                                                                                                                                                   7. Diocese:
2. Date of Submission:                                                             3. Reporting Month:                                             8. Contact Person:
3. Programme Focus (select only one):       Abstinence Only                      Abstinence and Being Faithful                                     9. Tel/cell:




                                                                                                                                                                                                                                                              Reporting Totals - PES
                                                                                                                                           Date          Date              Date             Date               Date               Date
                                                                                                                        Gender




                                                                                                                                                                                                                                          Secondary Reach



                                                                                                                                                                                                                                                                      or LSF
                                                                                                                           Session title




                                                                                                                                                                                                                            Beneficiary
                                                                                                                                                                                                                             Feedback
                                                                                                                                                                                                                              Session


                                                                                                                                                                                                                                             # reported
                     Name                                Surname                              ID or DOB




                                                                                                                                                          Participant initials verifying attendance each day

                                                                                                                          M F                                                                                                                                   MF
1
                                                                                                                          M F                                                                                                                                   MF
2
                                                                                                                          M F                                                                                                                                   MF
3
                                                                                                                          M F                                                                                                                                   MF
4
                                                                                                                          M F                                                                                                                                   MF
5
                                                                                                                          M F                                                                                                                                   MF
6
                                                                                                                          M F                                                                                                                                   MF
7
                                                                                                                          M F                                                                                                                                   MF
8
                                                                                                                          M F                                                                                                                                   MF
9
                                                                                                                          M F                                                                                                                                   MF
10
                                                                                                                          M F                                                                                                                                   MF
11
                                                                                                                          M F                                                                                                                                   MF
12
                                                                                                                          M F                                                                                                                                   MF
13
                                                                                                                          M F                                                                                                                                   MF
14
                                                                                                                          M F                                                                                                                                   MF
15
                                                                                                                          M F                                                                                                                                   MF
16
                                                                                                                          M F                                                                                                                                   MF
17

18                                                                                                                        M F                                                                                                                                   MF

                                          QUALITY CONTROL INFORMATION                                                                                     Summary Reach Data - PES or LSF
                  Data Collector - PE or LSF (1)              Quality controlled and collated to SSF - PES or LSF (2)                                            Number of males who attended 3 or more sessions: _____
           Name: ___________________________                         Name: ___________________________                                                          Number of females who attended 3 or more sessions: _____
          Position: ___________________________                     Position: ___________________________                                                                Total reported secondary reach: _____
          Sign:      ___________________________                    Sign:    ___________________________                                          This instrument was developed using those of the Harvard School of Public Health's                        22-Sep-08
          Date:      ___________________________                    Date:    ___________________________                                          Centre for the Support of Peer Education as a template.                                             SAR Ver 2
                                                                 AAHT - SIYAFUNDISA PROGRAMME
                                                                  Large Scale Public Gathering Form

                                               * For site level gatherings: PE to submit for collation on the first Sunday of the month
                                             * For Diocesan or National level gatherings: FW to capture within 7 days of the event
                                                    Summary Information for Data Collation and/or Capture
1. Level of event:               Site              Diocese             National                         8. Name and positions of main Siyafundisa presenters
2. Site Name (site level gatherings only):                                                                        Name and Surname                     Siyafundisa Position
3. Diocese Name:
4. Siyafundisa Programme:                          Life Skills      Peer Education
     (select only one)                             Both
5. Focus of Gathering:           Abstinence Only                  Abstinence and Be faithful
6. Date of Submission:
7. Reporting Month:                                                                                     9. Estimated number of attendees:

                                                                    Details of Large Scale Public Gathering

1. Topic/s addressed by large scale public gathering:                                               7. What about this large scale public gathering worked well and why?




2. Type of large scale public gathering:
             Mobile VCT                                                Candlelight
             Music concert                                             Food drive
             Youth Camp                                                Drama
             Award ceremony                                            Door to door
             Choir competition                                         World AIDS day
             Other (please specify)
3. Location of large scale public gathering:
4. Duration of large scale public gathering:
        Days:                           Hours:
5. Date/s of large scale public gathering:
        Start:                                            End:                                      8. Did anything go wrong at this gathering and how did you handle it?
6. What did you do for this large scale public gathering and why?




                                  Verification of Large Scale Public Gathering - to be completed by person responsible for venue
                               My signature confirms that this event took place, and that the details supplied above are correct and true.
                                                                  Signature:
                                                                  Name:
                                                                  Position:
                                                                  Date:
                                                                  Tel/Cell:


                                                                      QUALITY CONTROL INFORMATION
    Data Collector - FW for Diocese or National events                        Data Collator - PES or LSF                       Data Capturer - NOT for Site level events
            PE, PES or LSF for Site level events                                     only Ste level events                      M&E Officer for Diocese or National events
        Name                                                              Name                                                Name
 Designation                                                       Designation                                          Designation
         Sign                                                                 Sign                                             Sign
         Date                                                                 Date                                             Date
                          This instrument was developed using those of the Harvard School of Public Health's                                                            22-Sep-08
                          Centre for the Support of Peer Education as a template.                                                                                     LSPGF Ver 2
                                                            AAHT - SIYAFUNDISA PROGRAMME
                                                               One-on-one Contact Form A

                                                        *Sumbit for collation by first the Sunday of each month
                                                                         Summary Information
1. Name of Siyafundisa volunteer:                                                                       7. Summary data:
2. Gender of Siyafundisa volunteer:             Male           Female                                                  Contacts     Referrals      Repeats
3. Age of Siyafundisa volunteer:                                                                           Females
4. Site Name:                                                                                                 Males
5. Diocese:                                                                                             8. No of attached forms:
6. Reporting Month:                                                                                     9. Date of Submission:
      10. Number of peers with whom each topic was discussed:                                           11. Number of referrals to each institution:
 Topic of discussion     Total     Topic of discussion     Total                                Referral to       Total             Referral to                 Total
Abstinence                                HIV in family                                Clinic                                      Other
Bullying                                  Peer Pressure                                VCT                                           (Please Specify)
Careers                                   Physical abuse                               Peer Educator Sup
Caring for sick                           Pregnancy                                    Church counselor
Child headed home                         Relationships                                Police Stations
Dating                                    Sexual abuse                                 Social Services
Documentation                             VCT                                          Child Care Worker
Family issues                             STI                                          Life line
Family planning                           Other                                        Child Line
Grants and finance                              (Please Specify)                       Grant Offices
Grief and bereavement                                                                  School Counselor
                                                                          Contact Information
                                    Contact 1                                                                                Contact 2
Date of Contact:                                                                       Date of Contact:
Est. time of Contact:                                                                  Est. time of Contact:
Place of Contact:                                                                      Place of Contact:
Topic of Contact:                                                                      Topic of Contact:
Gender:           Male     Referral:      Yes             Repeat:       Yes            Gender:             Male       Referral:    Yes            Repeat:     Yes
                  Female                  No                            No                                 Female                  No                         No
Referral to:                                                                           Referral to:
Age:                                                                                   Age:
Additional Information:                                                                Additional Information:




                                    Contact 3                                                                                Contact 4
Date of Contact:                                                                       Date of Contact:
Est. time of Contact:                                                                  Est. time of Contact:
Place of Contact:                                                                      Place of Contact:
Topic of Contact:                                                                      Topic of Contact:
Gender:           Male     Referral:      Yes             Repeat:       Yes            Gender:             Male       Referral:    Yes            Repeat:     Yes
                  Female                  No                            No                                 Female                  No                         No
Referral to:                                                                           Referral to:
Age:                                                                                   Age:
Additional Information:                                                                Additional Information:




                                                                  QUALITY CONTROL INFORMATION
                         Data Collector - PE, PES, LSF                                                  Quality controlled and collated to SSF - PES or LSF
       Name                                                                                     Name
 Designation                                                                            Designation
         Sign                                      Date                                          Sign                                      Date
                         This instrument was developed using those of the Harvard School of Public Health's                                                    22-Sep-08
                         Centre for the Support of Peer Education as a template.                                                                            OOOCFA Ver 2
                                                            AAHT - SIYAFUNDISA PROGRAMME
                                                               One-on-one Contact Form _

                                           Name of Siyafundisa Volunteer:
                                                              Reporting Period:                                               Form ___ of ____
                                  Contact                                                                               Contact
Date of Contact:                                                                       Date of Contact:
Est. time of Contact:                                                                  Est. time of Contact:
Place of Contact:                                                                      Place of Contact:
Topic of Contact:                                                                      Topic of Contact:
Gender:        Male        Referral:      Yes            Repeat:        Yes            Gender:           Male     Referral:   Yes       Repeat:     Yes
               Female                     No                            No                               Female               No                    No
Referral to:                                                                           Referral to:
Age:                                                                                   Age:
Additional Information:                                                                Additional Information:




                                  Contact                                                                               Contact
Date of Contact:                                                                       Date of Contact:
Est. time of Contact:                                                                  Est. time of Contact:
Place of Contact:                                                                      Place of Contact:
Topic of Contact:                                                                      Topic of Contact:
Gender:        Male        Referral:      Yes            Repeat:        Yes            Gender:           Male     Referral:   Yes       Repeat:     Yes
               Female                     No                            No                               Female               No                    No
Referral to:                                                                           Referral to:
Age:                                                                                   Age:
Additional Information:                                                                Additional Information:




                                  Contact                                                                               Contact
Date of Contact:                                                                       Date of Contact:
Est. time of Contact:                                                                  Est. time of Contact:
Place of Contact:                                                                      Place of Contact:
Topic of Contact:                                                                      Topic of Contact:
Gender:        Male        Referral:      Yes            Repeat:        Yes            Gender:           Male     Referral:   Yes       Repeat:     Yes
               Female                     No                            No                               Female               No                    No
Referral to:                                                                           Referral to:
Age:                                                                                   Age:
Additional Information:                                                                Additional Information:




                        This instrument was developed using those of the Harvard School of Public Health's                                           22-Sep-08
                        Centre for the Support of Peer Education as a template.                                                                   OOOCFB Ver 2
                                                           AAHT - SIYAFUNDISA PROGRAMME
                                                                  Site Summary Form



1. Site Name:                                                                            2. Site Physical Address:
3. Diocese:
4. Form completed by (Name):
5. Position:
6. Contact Number:                                                                       8. Submission Date (dd/mm/yyyy):
7. Siyafundisa Programme:                Life Skills              Peer Education         9. Reporting Month
                                     Table 1.                                                                                      Table 5.
                        Total Session Attendance Data                                                              Summary One-on-one Contact Data
  Fill in the total number of males and females who have attended 3 or more                  Fill in the total number of contacts, repeats and referrals with male and female
                       sessions for each age group below.                                                                       peers below.
   Gender
                                                                                                                                         Number of
                         Males                 Females                  Total                   Gender            Total contacts                               Number of Repeats
                                                                                                                                         Referrals
  Age Group

10 - 13                                                                                        Females

14 - 18                                                                                          Males
                                                                                                                                   Table 6.
19 - 24
                                                                                                            Topics of and referrals from One-on-one Contacts
                                                                                          Fill in the total number of contacts for each topic listed below and the total number
Adult                                                                                                         of referrals to each of the services listed below.

                                                       Totals (A)                                                          Total                                         Total
                                                                                                      Topics                                     Referral to
                                    Table 2.                                                                              Contacts                                      Referrals
                      AB - Abstinence and Being faithful
Fill in the total number of males and females who have been reached in each
                          age group with AB messages.                                    Abstinence                                  Clinic
   Gender                                                                                Bullying                                    Child Care Worker
                         Males                 Females                  Total
  Age Group                                                                              Careers                                     Child Line
10 - 13
                                                                                         Caring for sick                             Church counselor
14 - 18
                                                                                         Child headed home                           Grant Offices
19 - 24
                                                                                         Dating                                      Life line
Adult                                                                                    Documentation                               Peer Educator Sup
                                                       Totals (X)                        Family issues                               Police Stations
                                     Table 3.
                            A only - Abstinence only                                     Family planning                             School Counselor
Fill in the total number of males and females who have been reached in each
                    age group with Abstinence only messages.                             Grants and finance                          Social Services
   Gender                                                                                Grief and bereavement                       VCT
                         Males                 Females                  Total
  Age Group                                                                                                                          Other
                                                                                         HIV in family
10 - 13
                                                                                         Peer Pressure
14 - 18
                                                                                         Physical abuse
19 - 24
                                                                                         Pregnancy
Adult                                                                                    Relationships
                                                       Totals (Y)                        Sexual abuse
Note: The total of table 1 (A) must equal the sum of the totals of tables 2 (X) and 3
                                        (Y).                                             VCT
                                 Table 4.
                  Summary of Large Scale Public Gatherings                               STI
                            Item                                        Total            Other
                                                                                                                             Table 7.
Number of community events:
                                                                                                                    Summary of Secondary reach
Estimated number of attendees at community events:                                       Total Secondary Reach


                                                                      QUALITY CONTROL INFORMATION
                           Data Collator - PES or LSF                                                      Quality controlled and captured to database - FW
          Name                                                        Docs attached                      Name
    Designation                                                                                    Designation
           Sign                                            Date                                           Sign                                         Date

                          This instrument was developed using those of the Harvard School of Public Health's                                                           22-Sep-08
                          Centre for the Support of Peer Education as a template.                                                                                      SSF Ver 2
                                                     AAHT - SIYAFUNDISA PROGRAMME
                                                       Participant Registration Form

                                           * One of these forms to be completed for each participant at every training and
                                                     submitted with the completed Training Attendance Register
                                                                      1. Personal Details
1. First Name:
2. Initials:
3. Last Name:
4. ID Number:                                                                    5. DOB (dd/mm/yyyy):
6. Gender:                       Male            Female
7. Cell:                                                                         8. Tel:
9. Fax:
10. E-mail:

                                                                   2. Training Programme
1. Please select the training type for which you are registering (Select only one) :
                  Peer Educator - Initial training                                              Monitoring and Evaluation
                  Peer Educator Supervisor - Initial training                                   HIV and AIDS
                  Life Skills Facilitator - Initial training                                    Training of Trainers
                  Peer Educator - Capacity building                                             Field Worker
                  Peer Educator Supervisor - Capacity building                                  Clergy
                  Life Skills Facilitator - Capacity building                                   Other (Please Specify)

                                                                      3. Location Details
      Peer Educators, Peer Educator Supervisors, Life Skills
                                                                                   Master Trainers, Field Workers and Management Personnel
                        Facilitators only
1. Diocese:                                                                      1. Diocese Name:
2. Site Name:                                                                    2. Office Address:
3. Site Address:


4. Site contact person:                                                          3. Office contact person:
5. Site Tel:                                                                     4. Office Tel:
                              4. Occupation                                           5. All previous Siyafundisa Training (select all that apply)
1. Are you a Siyafundisa volunteer?                Yes             No            1. Place a check in the box next to all Siyafundisa training
2. Are you a student?                              Yes             No               you have attended in the past.
3. Select your occupation form the list below ( only one)                                       Peer Educator - Initial training
        Full time Siyafundisa personnel                                                         Peer Educator Supervisor - Initial training
        Nurse                                                                                   Life Skills Facilitator - Initial training
        Health Care Worker                                                                      Peer Educator - Capacity building
        Community Worker                                                                        Peer Educator Supervisor - Capacity building
        Trainer                                                                                 Life Skills Facilitator - Capacity building
        Social Worker                                                                           Monitoring and Evaluation
        Psychologist                                                                            HIV and AIDS
        Teacher                                                                                 Training of Trainers
        Unemployed                                                                              Clergy
        Other (Please Specify)                                                                  Field Worker
                                                                                                Other (Please Specify

                                                                    Participant Signature
Participant Signature:                                                           Start date of Training:

                                                               QUALITY CONTROL INFORMATION
                          Trainer - Quality Control                                                          Trainer - Data Capturer
        Name                                                                            Name

 Designation                                                                     Designation

           Sign                                        Date                              Sign                                                Date

                       This instrument was developed using those of the Harvard School of Public Health's                                           22-Sep-08
                       Centre for the Support of Peer Education as a template.                                                                      PRF Ver 2
                                                                                        AAHT - SIYAFUNDISA PROGRAMME                                       Form __ of __
                                                                                          Training Attendance Register

                                                             * This form is to be accompanied by a completed Participant Registration Form for each participant.
                                                                          The Trainer should capture this data within 3 days of completion of training.
                                                                                               Training Information
1. Trainer Name:                                                                                                          7. Please select the type of training you are conducting (select only one)
2. Field Worker Name:                                                                                                                Peer Educator - Initial training                                      Monitoring and Evaluation
3. Training Date (dd/mm/yyyy):                                                                                                       Peer Educator Supervisor - Initial training                           HIV and AIDS
4. Reporting Month:                                                                                                                  Life Skills Facilitator - Initial training                            Training of Trainers
5. Venue Name:                                                                                                                       Peer Educator - Capacity building                                     Clergy
6. Training Diocese                                                                                                                  Peer Educator Supervisor - Capacity building                          Other (please specify):
                                                                                                                                     Life Skills Facilitator - Capacity building

                                                                                                                                            Date                   Date                    Date                    Date                Date
                   Name                          Surname                                 ID or DOB                     Gender
                                                                                                                                                          Initials of all participants in training to verify attendance on each date

 1                                                                                                                       M/F

 2                                                                                                                       M/F

 3                                                                                                                       M/F

 4                                                                                                                       M/F

 5                                                                                                                       M/F

 6                                                                                                                       M/F

 7                                                                                                                       M/F

 8                                                                                                                       M/F

 9                                                                                                                       M/F

10                                                                                                                       M/F

11                                                                                                                       M/F

12                                                                                                                       M/F

13                                                                                                                       M/F

14                                                                                                                       M/F

15                                                                                                                       M/F

16                                                                                                                       M/F

17                                                                                                                       M/F
                               QUALITY CONTROL INFORMATION                                                             Total Males
        Trainer - Quality Control                  Trainer - Data Capturer                                          Total Females

Name: ___________________________ ame: ___________________________ocs attached
                                N                                D                                                         TOTAL

Sign:                             Sign:
         ___________________________          ___________________________                                                                                                                                                                22-Sep-08
                                                                                                                       This instrument was developed using those of the Harvard School of Public Health's
Date:                            Date:
        ___________________________           ___________________________                                              Centre for the Support of Peer Education as a template.                                                           TAR Ver 2
                                                                         AAHT - SIYAFUNDISA PROGRAMME
                                                                            Beneficiary Feedback Form

                                                             *Sumbit for collation with the Session Attendance Register by the first Sunday
                                                                          following the last session recorded on the SAR form



1. Peer Educator Names /                                                                                              6. Target Age Group:                        10 - 13 yrs           14 - 18
Life Skills Facilitator Names:                                                                                                                                    19 - 24 yrs           Adults
                                                                                                                      7. Siyafundisa Programme:
2. Site Name:                                                                                                                                        Peer Education                  Life Skills
3. Diocese Name:                                                                                                      8. Programme focus area:
4. Date of Submission:                                                                                                                               Abstinence and Being faithful
5. Reporting Month:                                                                                                                                  Abstinence only

   Instructions
This exercise should be conducted by the group, facilitated by the Peer Educator or Life Skills Facilitator who has been leading the group. The facilitator should record the change observed that
most of the group feel is the most significant/important. The object of this exercise is to collect stories. Tell a story that describes the change, like a newspaper story. Try to attribute the change to
something - this may be a result of the Siyafundisa programme or something else in the community. Should the group not notice any changes this should be recorded.


      1. Looking back at the time during which you have been attending Peer Education / Life Skills training, what do you think was the most significant
      change in the attitudes and behavior of group members?




      2. Looking back at the time during which you have been attending Peer Education / Life Skills training, what do you think was the most significant
      change in the attitudes and behavior of the community?




                                                                               QUALITY CONTROL INFORMATION
                                        Facilitator                                                                                          Field Worker
        Name                                                                                               Name
 Designation                                                                                        Designation
         Sign                                                        Date                                   Sign                                                      Date
                                                                                                                                                                                                 22-Sep-08
                                                                                                                                                                                                 BFF Ver 2
                                                                     AAHT - SIYAFUNDISA PROGRAMME
                                                                       Peer Educator Feedback Form

                                                      *Sumbit directly to the Field Worker at every second visit of Field Worker to the site.
                                                                          This form must be completed twice each year
1. Peer Educator Names and ages:




2. Site Name:                                                                              4. Date of Submission:
3. Diocese Name:                                                                           5. Reporting Month:

  Instructions
This exercise should be conducted by a group of Peer Educators. One Peer Educator should be nominated the Facilitator and one to take notes. The facilitator should lead a discussion to obtain
agreement on the change observed that most of the group feel is the most significant/important. The note taker will record the change that the group finds most significant. The object of this
exercise is to collect stories. Tell a story that describes the change, like a newspaper story. Try to attribute the change to something - this may be a result of the Siyafundisa programme or
something else in the community. Should the group not notice any changes this should be recorded.

     1. Looking back at the last 6 months, what do you think was the most significant change in the attitudes and behavior of Peer Educators?




     2. Looking back at the last 6 months, what do you think was the most significant change in the attitude and behavior of the participants in sessions
     led by Peer Educators?




     3. Looking back at the last 6 months, what do you think was the most significant change in the attitudes and behavior of the community?




                                                                           QUALITY CONTROL INFORMATION
                                    Facilitator                                                                                        Field Worker
        Name                                                                                          Name
 Designation                                                                                   Designation
         Sign                                               Date                                        Sign                                                Date
                                                                                                                                                                                     22-Sep-08
                                                                                                                                                                                    PEFF Ver 2
                                                          AAHT - SIYAFUNDISA PROGRAMME
                                              Peer Educator Supervisor / Life Skills Facilitator Feedback Form

                                                    *Sumbit directly to the Field Worker at every second visit of Field Worker to the site.
                                                                        This form must be completed twice each year

1. Peer Educator Supervisor                                                                                     2. Date of Submission:
  or Life Skills Facilitator                                                                                    3. Reporting Month:
  Names:                                                                                                        4. Site Name:
                                                                                                                5. Diocese Name:
                                                                                                                6. Siyafundisa Programme:
                                                                                                                                              Peer Education            Life Skills

  Instructions
This exercise should be conducted together by 2 Peer Educator Supervisors or 2 Life Skills Facilitators at a site. The Peer Educator Supervisors or Life Skills Facilitators should discuss
the changes observed at the site and should record those that they feel are the most significant/important. The object of this exercise is to collect stories. Tell a story that describes the
change, like a newspaper story. Try to attribute the change to something - this may be a result of the Siyafundisa programme or something else in the community. Should the group not
notice any changes this should be recorded.

     1. Looking back at the last 6 months, what do you think was the most significant change in the attitudes and behavior of yourselves?




     2. Looking back at the last 6 months, what do you think was the most significant change in the attitude and behavior of the participants in
     sessions at the site?




     3. Looking back at the last 6 months, what do you think was the most significant change in the attitudes and behavior of the community?




                                                                         QUALITY CONTROL INFORMATION
                                    Facilitator                                                                                    Field Worker
        Name                                                                                         Name
 Designation                                                                                  Designation
         Sign                                             Date                                         Sign                                               Date
                                                                                                                                                                                 22-Sep-08
                                                                                                                                                                            PESLSFFF Ver 2
                                                                       AAHT - SIYAFUNDISA PROGRAMME
                                                                          Field Worker Feedback Form

                                                                    *Sumbit directly to the M&E Officer in November and May.


1. Field Worker Name:                                                                                             2. Date of Submission:
3. Diocese Name:                                                                                                  4. Reporting Month:

   Instructions
This exercise should be conducted individually by each Field Worker in each Diocese. The Field worker should record the changes that they feel are the most significant/important in their
Diocese. The object of this exercise is to collect stories. Tell a story that describes the change, like a newspaper story. Try to attribute the change to something - this may be a result of the
Siyafundisa programme or something else in the community.

      1. Looking back at the last 6 months, what do you think was the most significant change in your attitudes and behavior?




      2. Looking back at the last 6 months, what do you think was the most significant change in the attitudes and behavior of Peer Educators. Peer
      Educator Supervisors or Life Skills Facilitators in your diocese?




      3. Looking back at the last 6 months, what do you think was the most significant change in the attitude and behavior of the communities in your
      diocese?




                                                                            QUALITY CONTROL INFORMATION
                                     Field Worker                                                                                       M&E Officer
        Name                                                                                              Name
 Designation                                                                                       Designation
         Sign                                                   Date                                       Sign                                                Date
                                                                                                                                                                                        22-Sep-08
                                                                                                                                                                                      FWFF VER 2
                                                              AAHT - SIYAFUNDISA PROGRAMME
                                                                       Site Visit Form Page 1


                                            This form is to be completed once each quarter by the Field Worker at Site visits
1. Site Name:                                                                         5. Site Visitor Name:
2. Diocese:                                                                           6. Site visitor Tel/Cell:
3. Site Contact Person:                                                               7. Siyafundisa Programme:                 Peer Education       Life Skills
4. Contact Tel/cell:                                                                                                            Both


                 1. Progress and activities at the site following the challenges identified and way forward after the last Site visit:




   2. Number of youth at site participating in PE Programmes                             3. Number of youth at site participating in LS Programmes
    Gender                                                                                 Gender
                          Males                Females                 Total                                      Males                Females         Total
        Age                                                                                   Age

10 - 13                                                                               10 - 13
14 - 18                                                                               14 - 18
19 - 24                                                                               19 - 24
Adult                                                                                 Adult
Totals                                                                                Totals

    Data has been verified by attendance registers available at the site                   Data has been verified by attendance registers available at the site

                           4. M&E and Site Management and Operational Support - Field Worker to complete this section
1. All M&E documents are secure and specific data is organised and easy to find                                                         Yes            No
2. Instructions for M&E processes are available and accessible to all site level staff                                                  Yes            No
3. All M&E forms being used at the site are complete and up to date                                                                     Yes            No
4. The site has sufficient copies of all forms for the next 6 months                                                                    Yes            No
5. The Peer Educator Supervisor / Life Skills Facilitator maintains all M&E Documents on File                                           Yes            No
6. Site staff regularly receive M&E feedback                                                                                            Yes            No
7. Evidence of quality control is available on data collection and collation forms                                                      Yes            No
8. The site has sufficient trained Siyafundisa volunteer staff (9 - 12 x PE and 2 x PES or 2 x LSF)                                     Yes            No
9. I have met with the Priest at the site                                                                                               Yes            No
10. The site receives sufficient support from church personnel                                                                          Yes            No
11. Does the site have a document that details referral processes and organisations arround the site                                    Yes            No
12. I have conducted parent and community advocacy training during this site visit                                                      Yes            No
Comments:




                  This instrument was developed using those of the Harvard School of Public Health's                                                        7-May-08
                  Centre for the Support of Peer Education as a template.                                                                                 SVF Ver 1
                                                               AAHT - SIYAFUNDISA PROGRAMME
                                                                       Site Visit Form Page 2


                                            This form is to be completed once each quarter by the Field Worker at Site visits
1. Site Name:                                                                          5. Site Visitor Name:
2. Diocese:                                                                            6. Site visitor Tel/Cell:
3. Site Contact Person:                                                                7. Siyafundisa Programme:                Peer Education           Life Skills
4. Contact Tel/cell:                                                                                                            Both
                                             5. Site Programme Operation - PES / LSF to complete this section
1. The site has sufficient materials to conduct programme activities                                                                   Yes                 No
2. Peer Educator Supervisors / Life Skills Facilitators regularly receive funds for faxing                                             Yes                 No
3. Peer Educator Supervisors / Life Skills Facilitators regularly receive funds for time contribution                                  Yes                 No
4. The site receives sufficient support from the Diocesan Field Worker and Cape Town Office                                            Yes                 No
5. The site receives support from the priest and other site staff                                                                      Yes                 No
6. The programme has time allocated for programmes by the Priest or other relevant individual at the site                              Yes                 No
Comments from PES / LSF:




                                    Rating Guide:    1 - Strongly agree, 2 - Agree, 3 - Neutral, 4 - Disagree, 5 - Strongly disagree
                                     6. Session Observation and Impressions - Field Worker to complete this section
                 Item                                        Rating                                     Notes, Comments and Recommendations

PE / LSF are prepared for the
                                                1        2        3        4       5
session

PE/LSF worked well together as a
                                                1        2        3        4       5
team

PE/LSF exhibit a thorough
                                                1        2        3        4       5
understanding of the subject matter

PE/LSF respond appropriately to
                                                1        2        3        4       5
participants reactions

Beneficiaries enjoyed and actively
                                                1        2        3        4       5
participated in session

Session materials and activities are            1        2        3        4       5
appropriate for beneficiaries

                             7. Summary of challenges and successes highlighted by the site visit and agreed way forward:




                                                                QUALITY CONTROL INFORMATION
                        Field Worker                                                     PES or LSF                                          Data Capturer
 The information on this form is correct and has been shared     The information on this form is correct and has been shared    The data on this form has been captured
                with the PES / LSF at the site                                              with me                                             correctly
            Name
     Designation
              Sign
              Date

                     This instrument was developed using those of the Harvard School of Public Health's                                                       22-Sep-08
                     Centre for the Support of Peer Education as a template.                                                                                  SVF Ver 2
Date
  16-Apr-08
  17-Apr-08
  18-Apr-08
  21-Apr-08
  21-Apr-08
  21-Apr-08

  22-Apr-08
  22-Apr-08
  23-Apr-08
  23-Apr-08
  23-Apr-08
  23-Apr-08
  23-Apr-08
  23-Apr-08
  29-Apr-08




  29-Apr-08




  29-Apr-08




  29-Apr-08



  29-Apr-08




  5-May-08



  7-May-08
 15-May-08




 22-Sep-08
Information on changes
Initial development of Session Attendance Register based on CSPE Session Attendance Register
Initial development of the Large Scale Public Gathering Form based on the CSPE Community Event Form
Initial development of the One-on-one Contact Form based on the CSPE Face-to-face Discussion Form
Initial development of the Beneficiary Information Form
Added columns for beneficiary feedback session and secondary reach to Session Attendance Register
Add instruction line to One-on-one Contact form and
  put date and signature on same line for verification and added diocese
Changed age groups to 10 - 13, 14 - 18, 19 - 24 and Adults
Add Site Summary Form based on CSPE Site Summary Form
Add Participant Registration Form based on CSPE Participant Registration Form
Add Training Attendance Register based on CSPE Training Attendance Register
Changed "Reporting Period" to "Reporting Month"
Add MSC instrument for Peer Educators
Add MSC instrument for Peer Educator Supervisors and Life Skills Facilitators
Add MSC instrument for Field Workers
Changes to SAR following Pilot
     more space for the names of Peer Educators
     A only and AB need to be written out in full
     Summary reach data will be moved to the bottom of the form and complete by the Peer Educator Supervisor or the Life Skills F
     Specify roles under the quality control section
     Remove the section for daily totals
     This is the first version to be used by Siyafundisa Personnel Version 1
Changes to LSPGF following Pilot
     Changes to the wording of questions 6, 7 and 8
                  What did you do and why?
                  What about the event worked well and why?
                  What went wrong and how did you handle it?
     Specify roles and conditions under the quality control section
     This is the first version to be used by Siyafundisa Personnel Version 1
Changes to OOOCF following Pilot
     Add “Documentation” and “Per Pressure” to the available topics of discussion as these are recurring topics of contacts
     Add a table that includes the gender breakdown of referrals and Repeats to the summary section of the form.
     Specify roles under the quality control section
     This is the first version to be used by Siyafundisa Personnel Version 1
Changes to SSF following Pilot
     Make changes corresponding with changs on OOOCF
     Add field to QC section ot confirm attached supporting docs
     This is the first version to be used by Siyafundisa Personnel Version 1
Changes to PRF following Pilot
     Remove the majority of the Site Details from the Form
     Add “Unemployed” as an option under Occupation
     Change the headings of 5 for clarity
     This is the first version to be used by Siyafundisa Personnel Version 1
Changes to PRF and TAR following curriculum meeting
     QC responsibility of Trainer
     Add Diocese to location details
     Add Clergy to training type list
Add Site Visit Form based on CSPE Site Visit Form
Changed Staff to volunteer on OOOCF
Put topics and referrals in alphabetical order on OOOCF and SSF
Add initial instruction to TAR
Add Field Worker training to PRF Prior training list
Changed designation to Siyafundisa Personnel on LSPGF
Changed wording from 'For Office Use - Quality Control Information' to 'Quality Control Information' on all forms
Changed date(to 22 Sept 08) and version of document to Version 2 on all forms (bottom right hand corner on each form)
Added wording '(select only one)' to Items 3, 4 and 5 on the SAR
Added detail: (1) and (2) in Quality Control Information section of the SAR
Swaped order of 'Females' (placed at the top) and 'Males' in the Summary data box (Item 7) of the OOOCFA
Changed 'Name of Peer Educator' to 'Name of Siyafundisa Volunteer' on OOOCFB
Changed the word 'Programme' to 'National' on Item 1 of the LSPGF
Removed grey shading form sections for office use on all forms
ucator Supervisor or the Life Skills Facilitator




recurring topics of contacts
hand corner on each form)
           Source                       Data Collection

       Peer Educators /                  Peer Educators /
    Life Skills Facilitators          Life Skills Facilitators

         Conduct                         Collect data on
      PE / LS sessions             Session Attendance Register
    One-on-one Contacts             One-on-one Contact Form
Large Scale Public Gatherings   Large Scale Public Gathering Form

                                     Quality Control all forms
     Data Collation - Step 1                  Data Collation - Step 2

     Peer Educator Supervisors /
                                                     Field Worker
        Life Skills Facilitators

Receive original forms from PE / LSF        Receive all faxed forms from
                                              PES / LSF electronically
Quality control collection instruments
                                          Quality Control Site Summary form
         Collate data to the
         Site Summary Form                         Capture data to
                                             Siyafundisa M&E Database
 Quality Control Site Summary Form
                                            Quality Control Captured data
Fax all forms to E-mail to Field worker
                                                     Submit data
  File all forms at the site by month
                                           E-mail all forms to M&E Officer

                                              File all forms in electronic
                                                filing system by month
Collation - Step 3 and Reporting

            M&E Officer


   Receive all faxed forms from
     PES / LSF electronically

   Quality Control Captured data

Release data for inclusion in reports

 Generate reports for management
            and donors

     File all forms in electronic
       filing system by month
  Source             Data Collection

   Trainers               Trainers
Field Workers          Field Workers

  Conduct               Collect data on
  Training      Participant Registration Form
                Training Attendance Register

                          Trainers

                  Quality Control all forms
     Data Collation - Step 1             Data Collation and Reporting

              Trainers                               M&E Officer


  Take original forms from training         Receive all faxed forms from
                                               Trainer electronically
Quality control collection instruments
                                            Quality Control Captured data
           Capture data to
     Siyafundisa M&E Database                      Capture data to
                                             Siyafundisa M&E Database
    Quality Control Captured data
                                            Quality Control Captured data
            Submit data
                                         Release data for inclusion in reports
Fax all forms to E-mail to M&E Officer
                                         Generate reports for management
       File all forms by month                      and donors

                                              File all forms in electronic
                                                filing system by month
          Source                       Data Collection

       Project Team
                                     Diocesan Field Worker
       Diocesan FW

   Conduct / Participate in              Collect data on
Large Scale Public Gatherings   Large Scale Public Gathering Form

                                      Quality Control forms
      Data Collation             Collation - Step 2 and Reporting

   Diocesan Field Worker                     M&E Officer


       Capture data to                Receive faxed form from
 Siyafundisa M&E Database                FW electronically

Quality Control Captured data       Quality Control Captured data

         Submit data             Release data for inclusion in reports

 E-mail form to M&E Officer       Generate reports for management
                                             and donors
  File all forms in electronic
    filing system by month            File all forms in electronic
                                        filing system by month

				
DOCUMENT INFO
Description: Training Participant Feedback Form document sample