TeamSTEPPS 2.0: Module 9

Coaching Feedback Form

TeamSTEPPS is a teamwork system developed jointly by the Department of Defense (DoD)and the Agency for Healthcare Research and Quality (AHRQ) to improve institutional collaboration and communication relating to patient safety.


While observing the scripted coaching practice exercise, 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. 


Coaching Criteria Demonstrated
Yes No
Communication Instructions      
Providing Feedback      
Listening for Understanding      
Performance Improvement
Setting Performance Goals      
Rewarding Improvement      
Dealing With Failure      
Assessing Strength and Weaknesses      
Building Rapport and Trust      
Motivating Others      
Working With Personal Issues      
Confronting Difficult Situations      
Responding To Requests      
Following Through      

Return to Index

Page last reviewed March 2014
Page originally created September 2012
Internet Citation: TeamSTEPPS 2.0: Module 9. Content last reviewed March 2014. Agency for Healthcare Research and Quality, Rockville, MD.