TeamSTEPPS® Long-Term Care Version, Module 9

Coaching Feedback Form

Instructions:

While observing the scripted coaching role play, use this form to document the demonstrated competencies of the designated coach. The coach works through the designated issue with the team member, the team member acts out the particular scenario, and the observer watches the interaction and notes on the coaching observation form which competencies the coach exhibits and does not exhibit.

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Internet Citation:

TeamSTEPPS Long-Term Care Version, Module 9: Coaching Workshop. Coaching Feedback Form. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/teamsteppstools/longtermcare/module9/ltccoachfdbk.htm