Table 3.

Health Educator Observation Form

Monthly Meeting Activities		Task Completed by Health Educator?
I.	Weigh In & Tracking of Progress
	A. Obtain weight	YES	NO
	B. Plot weight and/or discuss progress	YES	NO
	COMMENTS
II.	Review diet and physical activity / Progress from previous meeting
	A. Talks about progress from last session/beginning of program	YES	NO
	B. If barriers identified, helps the participant problem solve	YES	NO
	C. IH – review logs; GR – access LoseIt!® data, provides feedback	YES	NO
	COMMENTS
III	Education / Lesson
	A. Adequately covered the main points of the lesson	YES	NO
	B. Generated good discussion with participant (or group if GR)	YES	NO
	C. Reads verbatim from the lesson plan	YES	NO
	COMMENTS
IV	Goal Setting
	A. Followed up on goals set at previous meeting	YES	NO
	B. Set new goals for the next month	YES	NO
	C. Did the health educator involve the participant when setting the new goals?	YES	NO
	COMMENTS
V	Incentives
	A. Were the shakes distributed and encouragement provided?	YES	NO
	B. Did the health educator provide support and encouragement for the next two weeks?	YES	NO
	COMMENTS
VII	Next Appointment
	A. Was the next meeting scheduled?	YES	NO
	COMMENTS