REPRODUCIBLE 183
How RTI Works in Secondary Schools • © 2012 Solution Tree Press • solution-tree.com
Visit go.solution-tree.com/rti to download this page.
Problem-Solving Team Plan Implementation Review
Use this form to document whether or not the intervention plan described on the Problem-Solving
Team Intervention Form was implemented as described. A member of the problem-solving team
should complete a direct observation of the intervention using an intervention checklist and attach
the completed form to this form. Teams then use the observation information to document the
implementation status of the intervention.
School or District:
Student: Review Date:
Intervention #: 1 2 3
Attach completed, dated, intervention script observation form from initial observation
INTERVENTION PROTOCOL INTEGRITY
Team agrees that the written intervention script fully matched the implemented intervention.
Team agrees that the written intervention script did not fully match the implemented intervention from the initial
observation.
Describe all revisions made to the intervention script:
Attach completed, dated intervention script observation form after revisions were made documenting intervention
integrity.
PLAN LOGISTICS INTEGRITY
Team agrees that the intervention occurred for the number and duration of sessions as designed on the plan
development form.
Team agrees that the intervention did not occur for the number and duration of sessions as designed on the plan
development form.
Describe differences between planned and actual intervention session number and length:
