Name date

CHECKLIST FOR HOME VIST

S.NO. STEPS/TASKS FIRST SECOND THIRD FOURTH FIFTH

ASSESSMENT ASSESSMENT ASSESSMENT ASSESSMENT ASSESSMENT

1. Organize the health education area

2. Follow the steps of the lesson plan

with objective
3. Give clear explanation on ther
subject matter.

4. Uses mpdulated voice local

language is loud clear explains in
simple terms
5. Intracts with the family ,participants
member and encourages discussion

6. Uses appropriate A.V aids which

well organized.
7. Clears doubts during the session .

8. Takes feedback for session

9. Summarize the topic clearly at the

end after conclusion .

INSTRUCTIONS :

Scoring is to be given as :

Performed well -2 perfromed average -1 did not performed -0

MAXIMUM SCORE : 9

SCORE OBTAINED :

REMARKS :

SIGNATURE OF STUDENT/FACULTY SIGNATURE OF SUPERVISOR