Test interview form

Coach name*
First Last
Coach email*
Officer Name*
First Last
Officer email*
Your report will be automatically sent to this email address.
Evaluation Key:
- Missed Step: User didn't complete the step.
- New User: Description of what this means.
- Intermediate User: Description of what this means.
- Advanced User: Description of what this means.
Step 1: Clearly state the desirable behavior and why you liked it.
Start time*
: minute
hour
End time*
: minute
hour
Score: Step 1*
Level of completion (new user)*
- Partial
- Complete
Level of completion (intermediate user)*
- Partial
- Complete
Level of completion (advanced user)*
- Partial
- Complete
Describe the details of the interaction with the client. (Step 1)*
Coach Feedback (Step 1)*
Step 2: Ask the offender to tell you the immediate benefits of engaging in the behavior.
Start time*
: minute
hour
End time*
: minute
hour
Score: Step 2*
Level of completion (new user)*
- Partial
- Complete
Level of completion (intermediate user)*
- Partial
- Complete
Level of completion (advanced user)*
- Partial
- Complete
Describe the details of the interaction with the client. (Step 2)*
Coach Feedback (Step 2)*
Step 3: Ask the offender to tell you what the future benefit will be if they continue to engage in the behavior.
Start time*
: minute
hour
End time*
: minute
hour
Score: Step 3*
Level of completion (new user)*
- Partial
- Complete
Level of completion (intermediate user)*
- Partial
- Complete
Level of completion (advanced user)*
- Partial
- Complete
Describe the details of the interaction with the client. (Step 3)*
Coach Feedback (Step 3)
Step 4: Gain the offender's commitment to continue to engage in the behavior
Start time*
: minute
hour
End time*
: minute
hour
Score: Step 4*
Level of completion (new user)*
- Partial
- Complete
Level of completion (intermediate user)*
- Partial
- Complete
Level of completion (advanced user)*
- Partial
- Complete
Describe the details of the interaction with the client. (Step 4)*
Coach Feedback (Step 4)*
General Observations
Was the situation appropriate for the skill used?*
- Yes
- No
Interaction strengths*
List any motivational interviewing skills — OARS — used; anchor your feedback with examples.
Improvement areas*
Conversation was focused on the criminogenic need?*
Yes No
Conversation enhanced intrinsic motivation?*
Yes Somewhat No
Conversation included skill training with directed practice*
Yes Somewhat No
Empathy Rating*
Low Moderate High
Empathy Rating*
Low Moderate High
Partnership Rating*
Low Moderate High

Step 1: Clearly state the desirable behavior and why you liked it.

Step 2: Ask the offender to tell you the immediate benefits of engaging in the behavior.

Step 3: Ask the offender to tell you what the future benefit will be if they continue to engage in the behavior.

Step 4: Gain the offender's commitment to continue to engage in the behavior

General Observations