Many similar comments appear throughout the evidence package. One could and logically would surmise that many projects have had a favorable impact on improving the safety and health of the AFF workforce. However, the evidence package, while providing significant evidence regarding programs in place, did not document an evaluation process that could provide evidence of the overall effectiveness of the AFF Program.

There is some evidence that program evaluations are conducted, but validation of program effectiveness in reducing injuries and illnesses is not robust and needs substantial improvement. A process for quantifying end outcomes and their impact on reductions in injuries and illnesses and the evaluation of programs from a qualitative perspective needs to be established for all AFF projects. The process would be linked to surveillance and designed to provide feedback that can be used to change program priorities or activities if the present course of action is not having a substantial impact. NIOSH would use a standard best-practices approach. An evaluation model such as the Centers for Disease Control and Prevention’s “Framework for Program Evaluation in Public Health” would be adopted and used consistently to quantitatively and qualitatively evaluate all projects and programs.

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