CQI Meeting Activity Log

Location (Office/County/Circuit/Region/State Office):	Date:

Participants:

AGENDA TOPICS

_____ Incidents, Accidents, and Client Grievances	_____ Staff/Client Satisfaction Data

_____ Program Evaluation Data	_____ Peer Record Review Data

_____ Improvement Projects	_____ Safety and Risk Management

_____ Other	_____ Past Issues

_____ Outcome Data

Summary of Data Reviewed:

Issues/ Concerns	What Are We Going To Do?	By Whom	Due Date	Desired Outcome