Fidelity Worksheet

Instructions: Look to the program guidelines provided by the developer or administrator of the evidence-based 

program (EBP) you have selected to see what is outlined as necessary to deliver the program with fidelity. If the 

program has been listed as a pre-approved program by the Administration for Community Living (ACL), or 

otherwise identified by ACL or another government agency (such as the Centers for Disease Control and 

Prevention (CDC), or the Substance Abuse and Mental Health Services Administration (SAMHSA) as meeting 

the standards for an evidence based program, then the program developers have included materials in their 

program manuals explaining how their program should be implemented. The literature showing the program 

works should outline the key aspects of the program that are necessary for success. You may also refer to

resources available at the Center for Healthy Aging of the National Council on Aging (NCOA) for information 

on program requirements.

This Fidelity Worksheet and the companion Fidelity Monitoring Tool are designed to help you identify what the 

program developer guidelines require for fidelity, plan how you will meet those guidelines when you first 

implement the program, and plan how you will monitor fidelity over time. Most programs will provide specific 

guidelines for the essential elements of fidelity listed here. If there are elements not listed, feel free to add them 

where it makes the most sense to you. 

As you review the materials, you will need to make some decisions about how often you will review fidelity, and 

how you will record the results of your review. This will allow you to build in a timeline for review, and also help 

educate people as they join your organization to understand what is needed to maintain fidelity. 

PROGRAM GUIDELINES

Program Program name

Is License required? Decision point: Who will be licensed? Will you track their contact and 

license number information?

What training is required? e.g., Leaders must complete 3-4 hours in-person training to be certified 

by program developer/administrator

How frequently? e.g., Training certification good for 2 years

Who is responsible for training? Decision point: Will your entity or someone else pay for or provide 

training? If someone else, how will you know they are doing it?

ESSENTIAL ELEMENTS OF FIDELITY

Training required of leaders Decision point: Will you track dates of certification? How frequently?

Number of Leaders e.g., 2 leaders

Length of course e.g., 6 weeks

Number of sessions e.g., 2 30-minute sessions per week

Class size e.g., 10-15 people

Target population e.g., Community-dwelling older adults with arthritis

Delivery mode e.g., In person with leader, self-paced

Content required e.g., Exercise, health education, scripted content

Materials for participants e.g., Participants provided workbook, resistance band

Fidelity Checklist e.g., Program-provided fidelity checklist to be filled out by observer one 

class per session

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REVIEW OF FIDELITY

Who is responsible for reviewing 

fidelity? 

Decision point: Will your entity or someone else be responsible for 

making sure the program is provided faithfully? Track their contact 

information and what documentation you would like to see from them.

Timeline for review e.g., Annually, Close of session

Number of class sessions observed e.g., 1 per session

Documentation reviewed e.g., Completed fidelity checklists, Fidelity Monitoring Tool

CONTACT INFORMATION

Program implementer Fidelity reviewer

Phone number Phone number

Email Email

ADDITIONAL INFORMATION

Include anything relevant that you 

would like to review in future

Decision point: You may want to track additional information such as 

whether a program is new or well-established, whether a leader is 

experienced or new, whether issues with this program have been 

identified and rectified in the past, or recommendations for future 

supervision. 

Suggestions for future 

improvements

Identify any issues discovered and propose solutions