Multi-tiered system of supports represents one of the most significant advancements in improving the outcomes of students for whom typical instruction is not effective. While many practices need to be in place to make multi-tiered systems of support effective, accurate implementation of evidence-based practices by individuals at all tiers is critical to obtain student outcomes. Effective strategies to achieve program fidelity are available; however, maintaining program fidelity at the individual level remains elusive. Lessons drawn from medicine indicate strategies to maintain program fidelity should address the implementer. Medical practitioners have used self-monitoring checklists to maintain fidelity with striking results. Research evaluating strategies to maintain program fidelity at the individual level represents an important next step in the field of education. Recommendations for a systematic research agenda focused on self-monitoring checklists are presented.