Instructions for EnhanceFitness Class Data Collection

Forms Sent to MI Department of Health and Human

FORM #1: Participant Information Form (PIF)

Completed by:
Participant
Purpose:
To provide basic demographic information about participant
How to Use:
  • Ask participant to fill in the requested details at or soon after their first class.
  • Send in to MDHHS (see address below).

FORM #2: Fitness Check Form

Completed by:
Instructor
Purpose:
To record information about participant's fitness status.
How to Use:
  • Conduct fitness checks...
    • at or soon after participant's first class
    • after 4 months of participation
    • however often (or if) fitness checks are conducted after 4 months according to what the EF site's procedures suggest.
  • Record information on the form as participant performs fitness check tasks.
  • Send in to MDHHS (see address below).

IMPORTANT! This form includes a Confidentiality Notice and asks participants to indicate whether or not they are willing to have their fitness data used for research. Please ensure that participants read the statement, check "yes" or "no", and sign and date the form.

FORM #3: Attendance Sheet

Completed by:
Instructor
Purpose:
To record attendance of participants
How to Use:
  • Pre-printed attendance sheets are provided to coordinators by MDHHS each month, and distributed to sites/instructors.
  • Record attendance at each session, by filling in a bubble for each participant present in the column for that day’s date.
  • When adding new names to an attendance sheet please print legibly.
  • Try to avoid duplicate participants. Each participant's name should appear only once on an attendance sheet.
  • Indicate participants who are no longer in the class and need to be removed by crossing their names out.
  • Add new participants to the bottom of the sheet on the blank lines, rather than to lines where other names have been crossed out.
  • Indicate any class time and/or day changes on the sheet at the upper right corner where that information appears.
  • Please consult with your coordinator for attendance sheet submission deadlines. MDHHS asks coordinators to submit sheets for the previous month by the 10th of each month, and provides the next month's sheets to coordinators by the 20th.

FORM #4: MI EF Document Cover Sheet

Completed by:
Instructor or Coordinator
Purpose:
Provides contact information for the individual submitting EF forms. Identifies sender in case MDHHS staff have questions about documents and helps them maintain up-to-date contact information.
How to Use:
  • Fill in the requested details regarding attached documents.
  • Send in to MDHHS, with documents such as PIFs, Fitness Check Forms and Attendance Sheets (see address below).

Forms NOT Sent to MI Department of Health and Human Services

FORM #5: MI EF Privacy Notice

Completed by:
Not applicable
Purpose:
To inform participants why personal information is collected, and how it is managed and used, and what options they have for allowing use of their personal information.
How to Use:
This form should be distributed to all participants (new and existing), and is theirs to keep. Once instructors are sure that existing participants have received a copy, they can simply continue to provide it to new participants.

FORM #6: Health History Form

Completed by:
Participant
Purpose:
To record information about the participant’s health status, as well as contact information, emergency contact information and liability release.
How to Use:
  • Ask participant to fill in the requested details at or soon after their first class.
  • Keep on-site for access to health and emergency contact information.

IMPORTANT! This form includes a Liability Waiver. Please ensure that participants read the statement, and sign and date the form.

FORM #7: Program Evaluation Form

Completed by:
Participant
Purpose:
To gauge participant's overall satisfaction with the class.
How to Use:
  • Ask participant to fill in the requested details
  • Time collection according to the EF site's procedures
  • Keep on site or send to coordinator, according to the EF site's procedures.

Extra: Participant Comments Form

Completed by:
Participant
Purpose:
To give participants an opportunity to give open-ended feedback on the class; both positive and negative.
How to Use:
  • Make available to participants to complete any time they have something they’d like to share.
  • Emphasize to participants the options of either giving the completed form to their instructor or sending/faxing it directly to MDHHS.


What to do with the completed forms

  • Quality Assurance: After participants complete their forms please clarify any unclear responses (blanks, cross-outs, multiple responses when one response is requested, etc.).
  • Signatures: Both the Fitness Check Form and the Health History Form require a signature (and "yes" or "no" indication of willingness to have data used for research on Fitness Check Form). Please be certain participant has signed and marked each form appropriately.
  • Where to Mail the Forms:

    MDHHS
    Attn: EnhanceFitness Program, 7th Floor
    PO Box 30195
    Lansing, MI 48909

If you have questions or concerns about these forms, please contact a MDHHS Arthritis Program staff person:


Karen McCloskey
McCloskeyK@michigan.gov
517-335-1236