OVERARCHING GOAL:
Objective # 1:
Origin of Objective
(i.e. HP 2020) / Data Source(s):
Baseline
Measurement / Target Measurement
Target Setting Method: / Target Setting Rationale:
Community Partners Involved:
Proposed Strategies
to Reach Target:
Objective # 2:
Origin of Objective
(i.e. HP 2020) / Data Source:
Baseline
Measurement / Target Measurement
Target Setting Method: / Target Setting Rationale:
Community Partners Involved:
Proposed Strategies
to Reach Target
Objective # 3:
Origin of Objective
(i.e. HP 2020) / Data Source:
Baseline
Measurement / Target Measurement
Target Setting Method: / Target Setting Rationale:
Community Partners Involved:
Proposed Strategies
to Reach Target
Objective # 4:
Origin of Objective
(i.e. HP 2020) / Data Source:
Baseline
Measurement / Target Measurement
Target Setting Method: / Target Setting Rationale:
Community Partners Involved:
Proposed Strategies
to Reach Target
DC Healthy People 2020 Worksheet-Objective Checklist
DC Healthy People 2020 Worksheet-Diverse Population Checklist
Objective #1: / ___ Gender: Male, Female*___ Race/Ethnicity: White, Black, Asian, Hispanic, Non-Hispanic or Other*
___ Age: Standard Census Age Groups*
___ Geographic Location: Wards 1-8 and/or Zip Code*
___ Education Level: Less than HS, HS Grad, Some College, College Graduate
___ Income Level: $0-$14,999, $15,000-29,999, $30,000-$44,999, $45,000-$59,999, $60,000-$74,999 or $75,000 and above
___ Health Insurance Status: Insured, Uninsured or Underinsured
___ Sexual Orientation: Heterosexual, Homosexual or Bisexual
___ County of Origin: Any Country of Origin
* Must have Gender, Race/Ethnicity, Age, Geographic Location data to create objective.
Objective #2: / ___ Gender: Male, Female*
___ Race/Ethnicity: White, Black, Asian, Hispanic, Non-Hispanic or Other*
___ Age: Standard Census Age Groups*
___ Geographic Location: Wards 1-8 and/or Zip Code*
___ Education Level: Less than HS, HS Grad, Some College, College Graduate
___ Income Level: $0-$14,999, $15,000-29,999, $30,000-$44,999, $45,000-$59,999, $60,000-$74,999 or $75,000 and above
___ Health Insurance Status: Insured, Uninsured or Underinsured
___ Sexual Orientation: Heterosexual, Homosexual or Bisexual
___ County of Origin: Any Country of Origin
* Must have Gender, Race/Ethnicity, Age, Geographic Location data to create objective.
Objective #3: / ___ Gender: Male, Female*
___ Race/Ethnicity: White, Black, Asian, Hispanic, Non-Hispanic or Other*
___ Age: Standard Census Age Groups*
___ Geographic Location: Wards 1-8 and/or Zip Code*
___ Education Level: Less than HS, HS Grad, Some College, College Graduate
___ Income Level: $0-$14,999, $15,000-29,999, $30,000-$44,999, $45,000-$59,999, $60,000-$74,999 or $75,000 and above
___ Health Insurance Status: Insured, Uninsured or Underinsured
___ Sexual Orientation: Heterosexual, Homosexual or Bisexual
___ County of Origin: Any Country of Origin
* Must have Gender, Race/Ethnicity, Age, Geographic Location data to create objective.
Objective #4: / ___ Gender: Male, Female*
___ Race/Ethnicity: White, Black, Asian, Hispanic, Non-Hispanic or Other*
___ Age: Standard Census Age Groups*
___ Geographic Location: Wards 1-8 and/or Zip Code*
___ Education Level: Less than HS, HS Grad, Some College, College Graduate
___ Income Level: $0-$14,999, $15,000-29,999, $30,000-$44,999, $45,000-$59,999, $60,000-$74,999 or $75,000 and above
___ Health Insurance Status: Insured, Uninsured or Underinsured
___ Sexual Orientation: Heterosexual, Homosexual or Bisexual
___ County of Origin: Any Country of Origin
* Must have Gender, Race/Ethnicity, Age, Geographic Location data to create objective.
Lead Person Signature: ______Date: ______