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| DOE-HDBK-1078-94
This example checklist could be used to judge whether a lesson plan meets predetermined standards
and is ready for use by an instructor.
To use this checklist each item must be compared to standards that are determined by your
Note:
individual facility. These standards should be included on this form.
Course/Program:
Author:
Revision No.:
Date:
/
/
Instructions to Reviewer: Place the appropriate letter in the blank provided--
S (Satisfactory), U (Unsatisfactory). If U is entered, explain why in the comment section:
=
Item is properly completed
S
=
Item is not completed or improperly completed
U
=
Not applicable.
N/A
Cover Page (A)
Course/program title
1.
2.
Module/title or unit number
Appropriate approvals (supervisor, SME, etc.)
3.
Prerequisites for module/unit
4.
5.
Page numbers with total pages of lesson plan listed
6.
Revision number and effective date (if initial lesson plan, write in date of lesson plan
completion)
Author's name
7.
8.
Revisor's name
9.
Learning objectives
10.
Learning objectives listed in sequence as taught
Approximate teaching time
11.
12.
Instructor references
13.
Trainee references.
Comments:
174
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