SayPro Impact Assessment Form

Below is a SayPro Impact Assessment Form for Emergency Preparedness Activities — designed to evaluate the effectiveness, reach, and outcomes of emergency preparedness efforts facilitated by SayPro and its partners.

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📋 SayPro Impact Assessment Form: Emergency Preparedness Activities

Form Title: Emergency Preparedness Impact Assessment
Prepared By: [Name / SayPro Office / Partner Organization]
Date of Assessment: [DD/MM/YYYY]
Assessment Period: [From – To]
Location: [Region / District / Community]

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1. Activity Information

Item	Description
Activity Name	[e.g., Emergency Simulation Training, Resource Stockpile Drill]
Type of Preparedness Activity	☐ Training ☐ Simulation ☐ Public Awareness ☐ Coordination Meeting ☐ Other (specify)
Lead Facilitator/Agency	[SayPro / Other Partner]
Partner Organizations Involved	[List all]
Target Group(s)	☐ Community Members ☐ Traditional Leaders ☐ Government Officials ☐ Youth Groups ☐ Volunteers ☐ Emergency Responders
Estimated Participants	[Number]

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2. Objectives of the Activity

• [Insert key objectives or intended outcomes as listed in the activity plan.]

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3. Assessment Indicators

3.1 Preparedness Outcomes

Indicator	Result / Rating	Evidence / Notes
% of participants with increased knowledge	[e.g., 85%]	Pre/Post-test results
Communities with updated emergency plans	[Number / %]	Verified plans available
Stakeholders trained in coordination roles	[Number]	Sign-in sheets, attendance records
Risk maps or evacuation routes created or revised	[Yes/No]	Include copy or summary

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3.2 Participation and Inclusion

Indicator	Result	Notes
Gender balance of participants	[M: ___ / F: ___]	Inclusivity goal met? Yes / No
Involvement of vulnerable populations	☐ Yes ☐ No	Specify groups involved
Traditional leadership engagement	☐ High ☐ Moderate ☐ Low	Number of Kings / Chiefs involved

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3.3 Logistics and Coordination

Indicator	Rating (1–5)	Comments
Quality of facilitation	[1–5]	Based on feedback forms
Coordination among partners	[1–5]	Joint planning effectiveness
Availability of training materials	[1–5]	Materials prepared and distributed
Venue and logistics setup	[1–5]	Accessibility, safety, equipment

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4. Community Feedback Summary

• What worked well?
  [Open response or bullet points from surveys / FGDs]
• What could be improved?
  [Open response or bullet points]
• Quotes from participants (if available):
  • “_____________________________________” – [Role / Name]
  • “_____________________________________” – [Role / Name]

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5. Lessons Learned and Recommendations

• Key Lessons Learned:
  [E.g., more hands-on simulations lead to better retention, Kings prefer localized messaging, etc.]
• Recommendations for Future Activities:
  [E.g., increase duration, include more remote communities, simplify tools]

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6. Attachments (If Applicable)

• ☐ Attendance List
• ☐ Pre/Post-Test Results
• ☐ Risk Maps or Planning Templates
• ☐ Photos of the Activity
• ☐ Partner Coordination Meeting Minutes

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7. Assessor Information

Name	Position / Organization	Contact Info

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Submit this completed form to:
📧 impact@saypro.org
🌐 www.saypro.org/impact

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