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.