Counselor observation checklist 2026

1. Click ‘Get Form’ to open the counselor observation checklist in the editor.
2. Begin by filling in the Peer Counselor's name, Clinic, and WIC ID # at the top of the form. This information is essential for identifying the participant.
3. Indicate whether the observation is for a Prenatal or Postpartum participant by checking the appropriate box.
4. Select the Observation Type by checking either Face-to-Face or Phone.
5. Fill in the Month/Quarter to specify when the observation took place.
6. Proceed to rate each counseling component under BREASTFEEDING COUNSELING by selecting 'Y', 'N', or 'N/A' as applicable. Provide comments where necessary to elaborate on your ratings.
7. In the sections labeled WHAT WENT WELL, WHAT CAN BE DONE DIFFERENTLY, and WHAT I WILL WORK ON - Improvement Goal(s), provide thoughtful feedback and goals for future sessions.
8. Finally, ensure that both the Peer Counselor and Reviewer sign and date their respective sections at the bottom of the form.

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