This is a template that I created to go with the new Ohio Teacher Evaluation System. The file is 6 pages. The first three pages so the form with a description of what the state is looking for in requirements. The second 3 pages are the blank form to plug in your lesson plan. This is what I used to acquire my accomplished rating with the state.
It is a blank 3 page form that can be printed and filled out traditionally or can be typed into and printed or saved on a computer. It can be altered to your liking. It could probably be used in other subject areas with some slight modifications.