Fidelity Data (Implementation Quotient Tracker)

IMPLEMENTATION QUOTIENT TRACKER
						Date of IRB approval: Expiration date of IRB approval: OMB No: EXPIRATION DATE: THE PAPERWORK REDUCTION ACT OF 1995: Public reporting burden for this collection of information is estimated to average 90 minutes per response, including the time for reviewing instructions, gathering and maintaining the data needed, and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number.
Instructions: The Implementation Quotient Tracker is designed to facilitate the calculation of a grantee's "implementation quotient". The implementation quotient is used to quantify the progress that a grantee has made toward implementation of the prescribed initiative. The implementation quotient is calculated by completing the table below on a quarterly basis beginning six months after the start of the summative evaluation. Each administration will take the individual designated to complete the table approximately 1.5 hours. Completion of the tracker is voluntary and participation and participation can be discontinued at any time without penalty of risk. The information in the spreadsheet will be kept private to the extent permitted by law. When the tracker is submitted to the PII evaluation team the " Practioner ID" column should be removed to ensure privacy. The grantee must keep a copy of the Implementation Quotient Tracker with the "Practioner ID" column for their records. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a current valid OMB control number.
Date:
Site:
1. Total Number Practitioner Positions Allocated to the Innovation
2. Number of Allocated Positions that are Vacant
3. Number of Staff Allocated to the Innovation as of MM/DD/YYYY
Position Number	Practitioner ID	The Practitioner is in Position. No=0 Yes=1	Initial Training has been Received. No=0 Yes=1	Coaching as Prescribed by the Coaching Plan has been Received. No=0 Yes=1	leslie cohen: upload performance assessment data that supports it..how often. Every 6 months. EL fills out. Performance Assessment Criteria Met Last Assessment No=0 Yes=1	Performance Assessment Criteria Met Consistently during the Prior Four Quarters . No=0 Yes=1	Practitioner Score
							0
							0
							0
							0
							0
							0
							0
							0
							0
							0
							0
							0
							0
4. Practitioner Position Sum (total of practioner scores)
5. Implementation Quotient= Practitioner Position Sum/ Allocated Position N