Appendix E: Example Logic Model Template

The following is an example of a “Logic Model” template. It is used as a road map to explain the intervention plan. This template/tool can be included within the CRR plan to assist in clearly outlining each program and/or strategy.

Program Name: Public Education

Problem Statement:
Fire-related deaths and injuries are occurring more frequently in three areas of our community (accounting for 63% of all calls).

Program Goal:
Provide safety education and home visits to prevent future instances. Reduce the risk by conducting 1,000 home safety inspections.

Resources Required:
0.5 FTE of public educator’s time
Assorted materials
Installation equipment
Smoke alarms


  • Conduct home visits
  • Distribute alarms
  • Do follow-up visits

(tangible products of activities)

No. of site visits
No. of alarms out
No. of follow-ups

Short-Term Impacts
(expected to see)

On follow-up visit, how many homes have smoke alarms installed (or changed batteries)

Intermediate Impacts
(want to see)

Community changed their behaviors, including conducting own home inspections

Long-Term Outcomes
(hope to see)

Significant reduction in fire rates in the target area of community

(explanation of how change occurs & program rationale)

The calls for service and resources expended on the target population are higher than expected. We expect that building relationships and teaching prevention skills to the target population will reduce risk and injury.

(factors or conditions assumed to be true)

The community is open to site visits. We will continue to have funds available to conduct follow-up visits.

External Factors:
Community expectations
Political implications