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Logic Model (Analytic Framework) Worksheet: Evidence-Based Public Health
Program Title:
Outcome
Goal:
Long-Term Objective:
Intermediate Objective
(Govt/Org Level):
Intermediate Objective
(Environmental Level):
Activities:
Activities:
Activities:
Activities:
Inputs:
Inputs:
Inputs:
Inputs:
Process
Inputs? What resources
are available to support
the program? What other
resources are needed?
Intermediate Objective
(Social Level):
Evaluation
Based on an evidence
review, what activities will
address these
determinants? What do
you do? How long will it
take?
Intermediate Objective
(Individual Level):
Impact
What are the evidencebased determinants?
Instructions: First discuss your target population. Using data, evidence-based recommendations (the Community Guide or others),
your own knowledge, and group discussion, develop a program strategy for your issue of focus. Define the goal, objectives, activities,
and costs: and enter them in this sample logic model worksheet.

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