Fillable MKPUSA NWTA Report 2020-01-01

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MKPUSA NWTA Report 2020-01-01

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The ManKind Project USA 2020-01-01
NWTA Report Page 1 of 3
The ManKind Project USA
NWTA Report
Only use Adobe Reader to fill out this form. The Area Administrator must submit this form electronically after reviewing it for accuracy
and completion. Confirm the Staff/MOS and New Brother rosters are correct in MKPConnect.org, download them and then submit all along
with unedited Group Photo and any Incident Reports to reports@mkp.org within 48 hours of Training. Instructions, tutorials and further
support for this document can be found here What Form What Purpose.
Include:
Staff/MOS
Roster (downloaded from MKPConnect)
Incident Reports (as needed, report in MKPConnect)
New Brother Roster (downloaded from MKPConnect
NWTA Group Photo (helpful instructions in MKPConnect)
MKP USA Area Name
Date of Training:
Facility Name
Facility Address
NWTA LEADER TEAM
Full Leader
Fee
Co-Leader
Fee
Co-Leader
Fee
Co-Leader
Fee
Co-Leader
Fee
Additional Leader
Fee
Ritual Elder
Ritual Elder Phone
LKS Lead Man
LKS Lead Man Phone
Medic
Medic Phone
Medic Email
CPR Certified Man 1
CPR Certified Man 2
Expiration Date
Expiration Date
Currently Active* LITs, CLCs and Leader Emeritus – please note role in parentheses beside name (LIT) (CLC) (LE)
* Verifying “Active” status for individuals in these roles is the joint responsibility of the Full Leader and Area Steward / Area Administrator
ATTENDANCE
Total Staff (Including Enrolled Leader Team):
Total Men of Service (MOS):
# Staff (Not including Enrolled Leader Team):
# of men on Enrolled Leader Team:
# Participants Who Arrived:
# Participants Who Completed:
# Participants Arrived, Did Not Complete:
Tuition Per Participant*:
* List Price NOT including discounts or PIT
Participants Who Left NWTA Early:
Names, Phone Numbers, And Reasons For Leaving
SAFETY SECTION
Total number Readiness Forms not submitted before standard
deadline (prior Thur 7p ET Staff/MOS, Tues 7p ET Participants)
Staff & MOS
Participants
Did the participants get at least 4 hours of sleep each night? Yes No
If NO, Describe in Medic Comments section
Were there any Illnesses, injuries, or unusual incidents?
Yes No
If YES, list below and complete Incident Report(s)
The ManKind Project USA 2020-01-01
NWTA Report Page 2 of 3
Complete and include a separate INCIDENT REPORT for each injury, illness, near miss or unusual incident and list below
Name and phone number
Name and phone number
Name and phone number
Name and phone number
LEADER TEAM REPORTS
Please take the time and space to comment on what could have been done better, as well as on what went well. Your feedback is vital to the
continued improvement of our trainings. These boxes will expand internally then scroll as you type. Using Adobe Acrobat, browsers, or other PDF
readers may cause problems. Use the latest version of Adobe Reader and this will work!
LEADER COMMENTS Name:
If YES, Describe:
LEADER: Were there any changes or
adaptations to the Protocol? Yes No
CO-LEADER COMMENTS Name:
CO-LEADER COMMENTS Name:
CO-LEADER COMMENTS Name:
CO-LEADER COMMENTS Name:
The ManKind Project USA 2020-01-01
NWTA Report Page 3 of 3
ADDITIONAL LEADER COMMENTS Name:
MEDIC COMMENTS Name:
RITUAL ELDER COMMENTS Name:
LKS LEAD MAN COMMENTS Name:
AREA STEWARD COMMENTS Name:
AREA ADMINISTRATOR COMMENTS
Name:
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MKPUSA NWTA Report 2020-01-01

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Completed 16 July 2020

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