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<table cellspacing="0" cellpadding="0">
<tbody>
<tr>
<td class="xl91" style="border-right: 0.5pt solid black; height: 46.5pt; width: 718pt; text-align: center;" colspan="7" width="956" height="62"><span style="color: #ff0000;"><strong>Instructions</strong></span></td>
</tr>
</tbody>
</table>
</td>
</tr>
<tr style="mso-height-source: userset; height: 42.6pt;">
<td class="xl72" style="height: 42px; width: 24px;" height="56">&nbsp;</td>
<td class="xl97" style="border-right: 0.5pt solid black; width: 927px; height: 42px;" colspan="6">For Persons in QI positions:</td>
</tr>
<tr style="mso-height-source: userset; height: 27.75pt;">
<td class="xl72" style="height: 27px; width: 24px;" height="37">&nbsp;</td>
<td class="xl95" style="border-right: 0.5pt solid black; width: 927px; height: 27px;" colspan="6"><span class="font6">&gt;</span><span class="font5"> Respond to all questions, using the scale provided below consider each statement and rate your own level of competency.</span></td>
</tr>
<tr style="mso-height-source: userset; height: 46.5pt;">
<td class="xl72" style="height: 46px; width: 24px;" height="62">&nbsp;</td>
<td class="xl95" style="border-right: 0.5pt solid black; width: 927px; height: 46px;" colspan="6"><span class="font6">&gt;</span><span class="font5"> This self-assessment tool is to aid you in identifying your personal needs for capacity building, so it is important that you reflect critically on your competency level and neither under- nor over-value your competency level.</span></td>
</tr>
<tr style="mso-height-source: userset; height: 76.5pt;">
<td class="xl72" style="height: 76px; width: 24px;" height="102">&nbsp;</td>
<td class="xl95" style="border-right: 0.5pt solid black; width: 927px; height: 76px;" colspan="6"><span class="font6">&gt;</span><span class="font5"> At the end of the assessment, summarize your key strengths and weaknesses and list concrete actions to be taken (e.g., short-term/long-term training, on-the-job/off-the-job training, and/or other capacity-building approaches) for strengthening specific competencies considered critical to your job performance and a timeline for achieving improvements. Your action plans should be inline with the assessment recommendations at the summary section.</span></td>
</tr>
<tr style="mso-height-source: userset; height: 38.25pt;">
<td class="xl91" style="border-right: 0.5pt solid black; height: 38px; width: 952px; text-align: center;" colspan="7" height="51"><span style="color: #ff0000;"><strong>Scoring&nbsp;</strong></span></td>
</tr>
<tr style="mso-height-source: userset; height: 46.5pt;">
<td class="xl73" style="height: 46px; width: 24px;" height="62">&nbsp;</td>
<td class="xl94" style="width: 792px; height: 46px;" colspan="3">Use the drop-down list in the &ldquo;Score&rdquo; column in the workbook to select the appropriate response for each question. The response categories are defined as follows.&nbsp;</td>
<td class="xl74" style="width: 65px; height: 46px;">&nbsp;</td>
<td class="xl74" style="width: 65px; height: 46px;">&nbsp;</td>
<td class="xl75" style="width: 2px; height: 46px;">&nbsp;</td>
</tr>
<tr style="mso-height-source: userset; height: 15.95pt;">
<td class="xl73" style="height: 15px; width: 24px;" height="21">&nbsp;</td>
<td class="xl90" style="width: 201px; height: 15px;"><strong>Competency Level</strong></td>
<td class="xl80" style="border-left: none; width: 386px; height: 15px;"><strong>Description</strong></td>
<td class="xl80" style="border-left: none; width: 203px; height: 15px;"><strong>Score</strong></td>
<td class="xl76" style="width: 65px; height: 15px;">&nbsp;</td>
<td class="xl76" style="width: 65px; height: 15px;">&nbsp;</td>
<td class="xl77" style="width: 2px; height: 15px;">&nbsp;</td>
</tr>
<tr style="mso-height-source: userset; height: 15.95pt;">
<td class="xl73" style="height: 15px; width: 24px;" height="21">&nbsp;</td>
<td class="xl99" style="border-bottom: 0.5pt solid black; border-top: none; width: 201px; height: 45px;" rowspan="3">Entry</td>
<td class="xl78" style="width: 386px; height: 15px;">Developing awareness/building knowledge</td>
<td class="xl99" style="border-bottom: 0.5pt solid black; border-top: none; width: 203px; height: 45px;" rowspan="3">0</td>
<td class="xl76" style="width: 65px; height: 15px;">&nbsp;</td>
<td class="xl76" style="width: 65px; height: 15px;">&nbsp;</td>
<td class="xl77" style="width: 2px; height: 15px;">&nbsp;</td>
</tr>
<tr style="mso-height-source: userset; height: 15.95pt;">
<td class="xl73" style="height: 15px; width: 24px;" height="21">&nbsp;</td>
<td class="xl79" style="width: 386px; height: 15px;">Limited skills</td>
<td class="xl76" style="width: 65px; height: 15px;">&nbsp;</td>
<td class="xl76" style="width: 65px; height: 15px;">&nbsp;</td>
<td class="xl77" style="width: 2px; height: 15px;">&nbsp;</td>
</tr>
<tr style="mso-height-source: userset; height: 15.95pt;">
<td class="xl73" style="height: 15px; width: 24px;" height="21">&nbsp;</td>
<td class="xl76" style="width: 386px; height: 15px;">&nbsp;</td>
<td class="xl76" style="width: 65px; height: 15px;">&nbsp;</td>
<td class="xl76" style="width: 65px; height: 15px;">&nbsp;</td>
<td class="xl77" style="width: 2px; height: 15px;">&nbsp;</td>
</tr>
<tr style="mso-height-source: userset; height: 15.95pt;">
<td class="xl73" style="height: 15px; width: 24px;" height="21">&nbsp;</td>
<td class="xl102" style="border-bottom: 0.5pt solid black; border-top: none; width: 201px; height: 60px;" rowspan="4">Novice</td>
<td class="xl81" style="width: 386px; height: 15px;">Limited experience</td>
<td class="xl99" style="border-bottom: 0.5pt solid black; border-top: none; width: 203px; height: 60px;" rowspan="4">1</td>
<td class="xl76" style="width: 65px; height: 15px;">&nbsp;</td>
<td class="xl76" style="width: 65px; height: 15px;">&nbsp;</td>
<td class="xl77" style="width: 2px; height: 15px;">&nbsp;</td>
</tr>
<tr style="mso-height-source: userset; height: 15.95pt;">
<td class="xl73" style="height: 15px; width: 24px;" height="21">&nbsp;</td>
<td class="xl82" style="width: 386px; height: 15px;">Unaware of potential problems</td>
<td class="xl76" style="width: 65px; height: 15px;">&nbsp;</td>
<td class="xl76" style="width: 65px; height: 15px;">&nbsp;</td>
<td class="xl77" style="width: 2px; height: 15px;">&nbsp;</td>
</tr>
<tr style="mso-height-source: userset; height: 15.95pt;">
<td class="xl73" style="height: 15px; width: 24px;" height="21">&nbsp;</td>
<td class="xl82" style="width: 386px; height: 15px;">Unaware of questions to ask</td>
<td class="xl76" style="width: 65px; height: 15px;">&nbsp;</td>
<td class="xl76" style="width: 65px; height: 15px;">&nbsp;</td>
<td class="xl77" style="width: 2px; height: 15px;">&nbsp;</td>
</tr>
<tr style="mso-height-source: userset; height: 15.95pt;">
<td class="xl73" style="height: 15px; width: 24px;" height="21">&nbsp;</td>
<td class="xl84" style="width: 386px; height: 15px;">&nbsp;</td>
<td class="xl76" style="width: 65px; height: 15px;">&nbsp;</td>
<td class="xl76" style="width: 65px; height: 15px;">&nbsp;</td>
<td class="xl77" style="width: 2px; height: 15px;">&nbsp;</td>
</tr>
<tr style="mso-height-source: userset; height: 15.95pt;">
<td class="xl73" style="height: 15px; width: 24px;" height="21">&nbsp;</td>
<td class="xl102" style="border-bottom: 0.5pt solid black; border-top: none; width: 201px; height: 60px;" rowspan="4">Proficient</td>
<td class="xl85" style="width: 386px; height: 15px;">Applies knowledge routinely</td>
<td class="xl99" style="border-bottom: 0.5pt solid black; border-top: none; width: 203px; height: 60px;" rowspan="4">2</td>
<td class="xl76" style="width: 65px; height: 15px;">&nbsp;</td>
<td class="xl76" style="width: 65px; height: 15px;">&nbsp;</td>
<td class="xl77" style="width: 2px; height: 15px;">&nbsp;</td>
</tr>
<tr style="mso-height-source: userset; height: 15.95pt;">
<td class="xl73" style="height: 15px; width: 24px;" height="21">&nbsp;</td>
<td class="xl82" style="width: 386px; height: 15px;">Basic skills</td>
<td class="xl76" style="width: 65px; height: 15px;">&nbsp;</td>
<td class="xl76" style="width: 65px; height: 15px;">&nbsp;</td>
<td class="xl77" style="width: 2px; height: 15px;">&nbsp;</td>
</tr>
<tr style="mso-height-source: userset; height: 15.95pt;">
<td class="xl73" style="height: 15px; width: 24px;" height="21">&nbsp;</td>
<td class="xl82" style="width: 386px; height: 15px;">Moderate amount of experience</td>
<td class="xl76" style="width: 65px; height: 15px;">&nbsp;</td>
<td class="xl76" style="width: 65px; height: 15px;">&nbsp;</td>
<td class="xl77" style="width: 2px; height: 15px;">&nbsp;</td>
</tr>
<tr style="mso-height-source: userset; height: 15.95pt;">
<td class="xl73" style="height: 15px; width: 24px;" height="21">&nbsp;</td>
<td class="xl84" style="width: 386px; height: 15px;">&nbsp;</td>
<td class="xl76" style="width: 65px; height: 15px;">&nbsp;</td>
<td class="xl76" style="width: 65px; height: 15px;">&nbsp;</td>
<td class="xl77" style="width: 2px; height: 15px;">&nbsp;</td>
</tr>
<tr style="mso-height-source: userset; height: 15.95pt;">
<td class="xl73" style="height: 15px; width: 24px;" height="21">&nbsp;</td>
<td class="xl102" style="border-bottom: 0.5pt solid black; border-top: none; width: 201px; height: 60px;" rowspan="4">Skilled</td>
<td class="xl81" style="width: 386px; height: 15px;">Solves problems that may arise</td>
<td class="xl99" style="border-bottom: 0.5pt solid black; border-top: none; width: 203px; height: 60px;" rowspan="4">3</td>
<td class="xl76" style="width: 65px; height: 15px;">&nbsp;</td>
<td class="xl76" style="width: 65px; height: 15px;">&nbsp;</td>
<td class="xl77" style="width: 2px; height: 15px;">&nbsp;</td>
</tr>
<tr style="mso-height-source: userset; height: 15.95pt;">
<td class="xl73" style="height: 15px; width: 24px;" height="21">&nbsp;</td>
<td class="xl86" style="width: 386px; height: 15px;">Aware of questions to ask and able to access&nbsp;</td>
<td class="xl76" style="width: 65px; height: 15px;">&nbsp;</td>
<td class="xl76" style="width: 65px; height: 15px;">&nbsp;</td>
<td class="xl77" style="width: 2px; height: 15px;">&nbsp;</td>
</tr>
<tr style="mso-height-source: userset; height: 15.95pt;">
<td class="xl73" style="height: 15px; width: 24px;" height="21">&nbsp;</td>
<td class="xl89" style="width: 386px; height: 15px;">resources to answer the questions.</td>
<td class="xl76" style="width: 65px; height: 15px;">&nbsp;</td>
<td class="xl76" style="width: 65px; height: 15px;">&nbsp;</td>
<td class="xl77" style="width: 2px; height: 15px;">&nbsp;</td>
</tr>
<tr style="mso-height-source: userset; height: 15.95pt;">
<td class="xl73" style="height: 15px; width: 24px;" height="21">&nbsp;</td>
<td class="xl84" style="width: 386px; height: 15px;">&nbsp;</td>
<td class="xl76" style="width: 65px; height: 15px;">&nbsp;</td>
<td class="xl76" style="width: 65px; height: 15px;">&nbsp;</td>
<td class="xl77" style="width: 2px; height: 15px;">&nbsp;</td>
</tr>
<tr style="mso-height-source: userset; height: 15.95pt;">
<td class="xl73" style="height: 15px; width: 24px;" height="21">&nbsp;</td>
<td class="xl102" style="border-bottom: 0.5pt solid black; border-top: none; width: 201px; height: 60px;" rowspan="4">Master</td>
<td class="xl85" style="width: 386px; height: 15px;">Uses knowledge fluently and effectively</td>
<td class="xl99" style="border-bottom: 0.5pt solid black; border-top: none; width: 203px; height: 60px;" rowspan="4">4</td>
<td class="xl76" style="width: 65px; height: 15px;">&nbsp;</td>
<td class="xl76" style="width: 65px; height: 15px;">&nbsp;</td>
<td class="xl77" style="width: 2px; height: 15px;">&nbsp;</td>
</tr>
<tr style="mso-height-source: userset; height: 15.95pt;">
<td class="xl73" style="height: 15px; width: 24px;" height="21">&nbsp;</td>
<td class="xl87" style="width: 386px; height: 15px;">Advanced skills</td>
<td class="xl76" style="width: 65px; height: 15px;">&nbsp;</td>
<td class="xl76" style="width: 65px; height: 15px;">&nbsp;</td>
<td class="xl77" style="width: 2px; height: 15px;">&nbsp;</td>
</tr>
<tr style="mso-height-source: userset; height: 15.95pt;">
<td class="xl73" style="height: 15px; width: 24px;" height="21">&nbsp;</td>
<td class="xl82" style="width: 386px; height: 15px;">Extensive experience</td>
<td class="xl76" style="width: 65px; height: 15px;">&nbsp;</td>
<td class="xl76" style="width: 65px; height: 15px;">&nbsp;</td>
<td class="xl77" style="width: 2px; height: 15px;">&nbsp;</td>
</tr>
<tr style="mso-height-source: userset; height: 15.95pt;">
<td class="xl73" style="height: 15px; width: 24px;" height="21">&nbsp;</td>
<td class="xl83" style="width: 386px; height: 15px;">&nbsp;</td>
<td class="xl76" style="width: 65px; height: 15px;">&nbsp;</td>
<td class="xl76" style="width: 65px; height: 15px;">&nbsp;</td>
<td class="xl77" style="width: 2px; height: 15px;">&nbsp;</td>
</tr>
<tr style="mso-height-source: userset; height: 15.95pt;">
<td class="xl73" style="height: 15px; width: 24px;" height="21">&nbsp;</td>
<td class="xl99" style="border-bottom: 0.5pt solid black; border-top: none; width: 201px; height: 45px;" rowspan="3">Expert</td>
<td class="xl81" style="border-top: none; border-left: none; width: 386px; height: 15px;">Anticipates problems before they arise</td>
<td class="xl99" style="border-bottom: 0.5pt solid black; border-top: none; width: 203px; height: 45px;" rowspan="3">5</td>
<td class="xl76" style="width: 65px; height: 15px;">&nbsp;</td>
<td class="xl76" style="width: 65px; height: 15px;">&nbsp;</td>
<td class="xl77" style="width: 2px; height: 15px;">&nbsp;</td>
</tr>
<tr style="mso-height-source: userset; height: 15.95pt;">
<td class="xl73" style="height: 15px; width: 24px;" height="21">&nbsp;</td>
<td class="xl82" style="border-left: none; width: 386px; height: 15px;">Poses questions to the team&nbsp;</td>
<td class="xl76" style="width: 65px; height: 15px;">&nbsp;</td>
<td class="xl76" style="width: 65px; height: 15px;">&nbsp;</td>
<td class="xl77" style="width: 2px; height: 15px;">&nbsp;</td>
</tr>
<tr style="mso-height-source: userset; height: 15.95pt;">
<td class="xl73" style="height: 15px; width: 24px;" height="21">&nbsp;</td>
<td class="xl88" style="border-left: none; width: 386px; height: 15px;">Sought out for input</td>
<td class="xl76" style="width: 65px; height: 15px;">&nbsp;</td>
<td class="xl76" style="width: 65px; height: 15px;">&nbsp;</td>
<td class="xl77" style="width: 2px; height: 15px;">&nbsp;</td>
</tr>
</tbody>
</table>