COMPETENCY REVIEW AND EVALUATION GUIDE - …pdp.coto.org/PDP/LMS_Library/Competency_Review_Guide_Step2.pdf · COMPETENCY REVIEW AND EVALUATION GUIDE: STEP 2 ... OTs are encouraged

© 2012, College of Occupational Therapists of Ontario

COMPETENCY REVIEW AND EVALUATION GUIDE: STEP 2 GUIDE


TABLE OF CONTENTS

Introduction ...................................................................................................................... 1The two steps of Competency Review and Evaluation ...................................................................................1What is the role of the Quality Assurance Committee in Step 2? .................................................................1 What is a Peer Assessor? .....................................................................................................................................1How does being selected for Step 2 affect me? ................................................................................................2

Frequently Asked Questions ................................................................................................ 2Why do I have to engage in Step 2? ...................................................................................................................2Are the results kept confidential? ......................................................................................................................2May I request a deferral? ....................................................................................................................................2

Decision Tree: The Competency Review and Evaluation Process ............................................. 3

Competency Review and Evaluation Checklist ....................................................................... 4

A) Submitting the required information ............................................................................. 5 The QA Delivery System Supports ...........................................................................................................5 Accessing the QA Program Delivery System ..........................................................................................5

B) Completing the online Pre-Questionnaire ...................................................................... 5 How to submit the Pre-Questionnaire.....................................................................................................5

C) Completing the online Availability and Conflict of Interest ............................................... 6 Determining a conflict of interest with Peer Assessors .........................................................................6 How to indicate a conflict of interest and assessment details ...............................................................6 Arranging a place for your assessment ....................................................................................................6

D) Communicating with your Peer Assessor and the QA Program Manager ............................. 6 How to email your Peer Assessor and the QA Program Manager .......................................................6 How to retrieve an email message ............................................................................................................7

E) What to bring to your Practice Assessment .................................................................... 7 Arranging to obtain client charts .............................................................................................................7 Collecting other documents ......................................................................................................................8

F) Preparing for your Practice Assessment ......................................................................... 8 Reviewing College documents ..................................................................................................................8 Reflecting on your practice .......................................................................................................................9

G) What to expect during your Practice Assessment ............................................................ 9 A typical schedule .......................................................................................................................................9 Case-based questions .................................................................................................................................9 Situation-based questions ........................................................................................................................10 Chart Review .............................................................................................................................................10

H) Finding out the results of your Practice Assessment ...................................................... 10 The Competency Evaluation Report ......................................................................................................10 Submit a response using the QA Online Delivery System ..................................................................10 What to include in a written submission ..............................................................................................11

I) Potential outcomes of your Practice Assessment .......................................................... 11 Notice of intent to make a decision ........................................................................................................12 Final QA Committee decision ................................................................................................................12 College contact information .............................................................................................. 12

ResourcesStep 2 Checklist ....................................................................................................................................................4Employer Letter: Access to client information and records ........................................................................13Request for Deferral ..........................................................................................................................................14


© 2012, College of Occupational Therapists of Ontario 1

COMPETENCY REVIEW AND EVALUATION GUIDE: STEP 2

INTRODUCTION

Welcome to the College of Occupational Therapists of Ontario’s (the College’s) guide to Step 2 of the Competency Review and Evaluation process. This document provides an overview of the Competency Review and Evaluation process and detailed information on Step 2.

Competency Review and Evaluation is one component of the College’s Quality Assurance (QA) Program. By providing feedback, this educational two-way process encourages the occupational therapist to improve his or her practice.

For more information on the QA Program, visit the College website, www.coto.org.

THE TWO STEPS OF COMPETENCY REVIEW AND EVALUATION

Step 1: The first step monitors compliance with the QA Program’s mandatory requirements (submitting portfolio materials) and engages the Registrant in a multi-source feedback survey process.

Step 2: The second step involves an in-depth, focused assessment of selected Registrants’ knowledge, skill and judgment in relation to the standards of the profession. The focus of Step 2 is a behaviour-based interview (BBI) in which the Registrant is asked case-based and situation-based questions. During this in-person interview, several of the Registrant’s client charts are reviewed. The BBI evaluates the OT’s adherence to Essential Competencies of Practice for Occupational Therapists in Canada, 3rd Edition. OTs are encouraged to use the Step 2 assessment results to focus their learning goals and develop an effective professional development plan.

What is the role of the Quality Assurance Committee in Step 2?The College’s QA Committee is responsible for appointing Peer Assessors, reviewing the Peer Assessors’ written reports and determining the outcomes of the assessments.

The QA Committee directs every assessment. To obtain the information it requires to make a decision, the QACommittee may specify additions or changes to the standard process.

What is a Peer Assessor?A Peer Assessor is an experienced OT who has been trained to conduct a practice assessment. By reviewing aRegistrant’s client records and conducting a BBI, the Peer Assessor gathers information about the OT’s practice, and identifies areas of strength and weakness in relation to the Essential Competencies. The Peer Assessor provides a written report to both the Registrant and the QA Committee.

COMPETENCY REVIEW AND EVALUATION: STEP 2 GUIDE




How does being selected for Step 2 affect me?Registrants chosen to participate in Step 2 are required to complete all of the following expectations by the specified due date.

1. Read this guide carefully.2. Use the “Step 2 Checklist” on page 4 to ensure that you fulfill all of your requirements.3. Access the online Practice Development Portal.4. Complete the online Pre-Questionnaire and online Registrant information section in the Step 2 Menu tab.5. Book a quiet, private location for the four-hour assessment.6. Retrieve the charts of your last 10 consecutively discharged clients to review with the Practice Assessor.7. Collect relevant materials – such as your billing information and flow sheets – for the Practice Assessor to review. (For the full list of required documents, see “Collecting other documents” on page 8.)8. Participate in the four-hour Practice Assessment on the date and time that the College specifies.

FREQUENTLY ASKED QUESTIONS

Why do I have to engage in Step 2?Each year, the College randomly selects a number of Registrants to participate in Competency Review and Evaluation Step 1 process. Registrants are required to participate in the Step 2 if the Registrants multi-source feedback survey results fall below the established threshold and/or his/her portfolio material demonstrates consistence lack of participation in Competency Enhancement. The QA Committee, however, may require an OT to participate in Step 2 at any time.

Are the results kept confidential?All Registrant information acquired during the process will be used for QA purposes only and is kept confidential within the QA Program. It will not be used in other College proceedings. The College will not notify your employer of your participation in Step 2 or inform your employer of the outcome of your assessment. If the employer must be notified to obtain client charts for the Chart Review component of the assessment, it is the Registrant’s responsibility to advise his or her employer of the process. The College, when asked by the Registrant, will help inform the employer about the process.

May I request a deferral?The College may postpone your participation in Step 2 upon written request if your reason for requesting the deferral meets specific criteria. Every request is considered individually. The College may need to contact you to obtain further information before making its decision. To request that your assessment be postponed, complete the “Request for Deferral” included in your information package.

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Decision Tree: The Competency and Review Evaluation Process

© 2012, College of Occupational Therapists of Ontario4


April 2008 53542

Quality Assurance Program Competency Review and

Evaluation: Step 2 Checklist

Registrant Name: Registration Number:_________________________ ___________________________

Check one boxper line

College Use Only

Please submit online the following materials by the due date:

SUBMITTED/ ORGANIZED

N/A NC FL

1. Complete Pre-questionnaire (online: Pre-questionnaire tab) 2. Determine conflict of interest (online: Your Profile tab)3. Indicate preferred Assessment location (online: Your Profile tab) 4. Select 4 possible dates (online: Your Profile tab)

Please make available the following documents on the day of the assessment:

10 consecutive records of discharge clientsAdvertising materials (if applicable)Billing information/invoice Business card (if applicable)

Following confirmation of the assessment date please make the following arrangements:

Book location/room (private location with access to an electrical outlet for a laptop and a table with two chairs)

Book time (4 hrs) Other _________________________________

Sample


A) SUBMITTING THE REQUIRED INFORMATION

The College has implemented a confidential, password-protected online system to support efficient communication between the College, Peer Assessors and Registrants engaged in Step 2. Only the Quality Programs Manager and Associate, the QA Committee, the Peer Assessor assigned to the assessment and the Registrant have access to the Registrant’s QA profile, Pre-Questionnaire, assessment details and reports. This information is not shared with the public, other Registrants, the Registrant’s employer(s), or other College departments and Committees.

The QA Delivery System supports:• transmission of confidential messages between the QA Administrator, the Peer Assessor and the Registrant. (Portal mailbox);• completion and review of the Pre-Questionnaire (Pre-Questionnaire tab);• updating of the Registrant’s QA profile and selecting an assessment location (Peer/practice assessment tab);• reviewing the confirmed assessment details, including the location, date and time (Peer/practice assessment tab);• reviewing the completed assessment report; • accessibility of the QA resources and documents (Introduction tab);• completing the Post Questionnaire feedback form.

Accessing the QA Program Delivery System

To access the QA Delivery System, follow these steps.1. Visit the College website, www.coto.org.

2. Log onto the “Registrant Only” section by entering your registration number and password.

3. Click on the Practice Development Portal link

4. Click on the Step 2 Menu tab (top left side)

All instructions are indicated.

B) COMPLETING THE ONLINE PRE-QUESTIONNAIRE

To initiate your Practice Assessment, complete the Pre-Questionnaire in the Portal. The Pre-Questionnaire provides the College with general information about your practice and role.

How to submit the Pre-Questionnaire1. Access the Portal.

2. Click on the Step 2 Menu.

3. Select the Pre-Questionnaire top tab.

4. Click on “Click here to begin your Pre-Questionnaire”.

5. Answer the questions that relate to your practice.

6. When all answers have been completed click “exit” – you will have the option to either: save and return to the

questionnaire or complete it (which changes it to a read-only document). Once the questionnaire is completed

it is automatically submitted to the College.

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C) COMPLETING THE ONLINE AVAILABILITY AND CONFLICT OF INTEREST SECTION

The College requires that you indicate your availability and conflict of interest in the Portal. After you have indicated your availability, and determined any conflict of interest, the College will notify you of the assessment date, time and location within 7 – 10 days.

Determining a Conflict of Interest with Peer AssessorsIf you have a personal or professional relationship with an OT whom the QA Committee has contracted to be aPeer Assessor, it may compromise the objectivity of the assessment. You are required to indicate if you have a conflict of interest with a potential Peer Assessor.

How to indicate a conflict of interest and assessment details1. Access the Step 2 Menu tab.

2. Click on the ”Peer/practice assessment” tab.

3. Under the “section to be completed by Registrant” title, click on the names of the Practice Assessors who

may pose a conflict of interest (for multiple assessors, control (ctrl.) click all the names)

4. Provide four dates when you are available.

5. Indicate your preferred location for the assessment

6. Click on “my section is completed” when you are happy with the information indicated

N.B. Employers are not required to pay for time spent in QA activities, so you may need to take half of a vacation or leave-of-absence day.

Arranging a place for your assessmentYou are responsible for booking the location of your Practice Assessment. Typically, the assessment is conducted at the OT’s place of employment. If the OT is in private practice, the assessment is usually performed in the OT’s home. Some OTs request that the assessment be conducted at a different location, such as a library or com-munity centre. You are responsible for any costs related to booking the assessment area. Choose a location that is quiet and private. Public areas, such as a coffee shop, cafeteria or lunchroom, are inappropriate. The location should have a large table on which to review the client charts, two chairs and access to an electrical outlet for the Peer Assessor’s laptop. The location must be available for the entire four-hour assessment.

D) COMMUNICATING WITH YOUR PEER ASSESSOR AND THE QA PROGRAM MANAGER

You can send a confidential email message to your Peer Assessor and the QA Program Manager through the Portal Mailbox.

How to email your Peer Assessor and the QA Program Manager1. Access the Portal.

2. Click on the ”Portal Mailbox” tab in the top left corner.

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3. Select “compose a new message” located at the bottom of the screen.

4. Choose the intended recipient type, either “administrator” or “assessor”.

5. Choose the specific name of the recipient.

6. Compose your message by typing in the message window.

7. Click “send” at the bottom of the screen.

When your Peer Assessor or the QA Manager emails you, an “email alert” will appear in your personal email inbox. The message will ask you to check for the email in the Portal.

How to retrieve an email message1. Access the Portal.

2. Click on the ”Portal Mailbox” tab.

3. Click “Portal Mailbox” at the top of the box.

4. Ensure “select your mailbox” is on “received mail”

5 Click on “view message”

6. To respond to the message, click “Reply.”

E) WHAT TO BRING TO YOUR PRACTICE ASSESSMENT

You need to bring the charts for your last 10 consecutively discharged clients to the Practice Assessment. You also need to bring other documents that pertain to your practice; for example, your master signature sheet.

Arranging to obtain client chartsWhen you obtain the charts of your last 10 consecutively discharged clients, be sure to include records that may be retained separately, such as:

• copies of original signed assessment reports;• rough notes or raw data;• care protocols;• service visit records; and• financial records and/or receipts for client billings.

If the records are electronic, print the records before your assessment. In accordance with the Health Professions Procedural Code under the Regulated Health Professions Act, 1991, ss 82 (1)(c), the College and Peer Assessors have the authority to request access to and review client records for the purpose of conducting an assessment and gathering information about an OT’s client care. You do not require client consent to allow the Peer Assessor to review these records. You are encouraged to follow the policies that your practice setting has set out to access client records. Although the College does not require you to inform your employer of your participation in Step 2, in some practice settings this may be necessary to retrieve client charts.

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The College has prepared a letter that you can give to your employer if he or she would like information on access-ing client charts for QA purposes. “Access to Client Information and Records” is on page 13. You or your employer may also consult with the College’s Manager of Quality Programs. Refer to page 12 for contact information.

Collecting other documentsDuring the assessment, the Peer Assessor will review a variety of your forms, records, reports and promotional materials. Examples of specific documents that you are required to bring to the Practice Assessment include:

• progress and assessment notes• flow sheets• master signature sheet• referral forms• consent forms and related documentation• discharge note/referrals• final reports• care protocols• service visit records or appointment records• invoicing materials• advertising materials and your business card, if applicable

F) PREPARING FOR YOUR PRACTICE ASSESSMENT

You are encouraged to prepare for your Practice Assessment by reviewing College documents and reflecting on particular situations that you have encountered as an OT.

Reviewing College documentsThe College suggests reviewing the following documents prior to the assessment. You will find these documents on the College website, www.coto.org, located in Resource Room and in the Portal’s Practice Resources section.• Essential Competencies of Practice for Occupational Therapists in Canada, 3rd Edition• Standards for Occupational Therapy Assessment• Standards for Record Keeping• Standards for Consent• Standards for Occupational Therapy Assessment• Standards for Professional Boundaries• Guideline on the Controlled Acts and Delegation• Position Statement: Use of Title• Code of Ethics• Professional Misconduct Regulation: Official Regulations

In addition, you are encouraged to review any other regulations or College practice guidelines that pertain to your practice.




Reflecting on your practiceDuring the assessment, the Practice Assessor will ask you to recall various situations, including when you:

• took action to minimize risk to a client, yourself or others;• responded to incompetent, unsafe or unethical client care;• advocated for access to OT services on behalf of a client or group of clients; and• ensured consistency with regulatory requirements and practice setting policies.

To prepare to answer these questions, recall situations in which you managed these issues. As well, review the Essential Competencies and Performance Indicators that address these issues in Essential Competencies of Practice for Occupational Therapists in Canada, 3rd Edition.

G) WHAT TO EXPECT DURING YOUR PRACTICE ASSESSMENT

The Peer Assessor will conduct a behaviour-based interview (BBI). In this context, the philosophy of the BBI is that past practice behaviours accurately predict future practice behaviours.

A typical scheduleWhile Peer Assessors follow a standard process, variations may occur. Here is a typical Practice Assessment schedule.

Introduction – 5 minutesChart Review – 90 minutesBreak – 10 minutesCase-based questions – 60 minutesBreak – 10 minutesSituation-based questions – 60 minutesClosing – 5 minutes

Case-based questionsThese questions require you to recall a specific case. The Peer Assessor will invite you to review one of your charts to help you recall the case.

Sample question: Describe the steps you took to determine the appropriateness of this referral for this specific case. How did you screen the referral? How did you determine you had the knowledge, skill and abilities re-quired to accept the referral? How did you explain your scope of practice and role to the client?

Your answers to these questions help the assessor determine if you met several Performance Indicators, including the following:

4.1.1 Identifies the recipient(s) of occupational therapy service as the client(s).4.1.3 Identifies the knowledge, skills and attitudes required to provide appropriate service to the client.4.1.6 Establishes with the client a shared understanding of occupation, occupational performance, engagement, and enablement issues.



Situation-based questionsThese questions are based on recent situations. The Practice Assessor will ask you to provide details that demonstrate the competencies being assessed.

Sample question: OTs are expected to ensure consistency with regulatory requirements and the policies of the practice setting. Can you think of a recent situation in which your practice setting policies and your professional responsibility were inconsistent? Describe that situation for me.

Your description and explanations will help the Assessor determine if you met the following Performance Indicator:

7.3.3 Takes appropriate action to align consistency of practice environment requirements with regulatory requirements.

Chart ReviewThis review assesses your knowledge and skill in meeting the College’s Standards for Record Keeping. During this educational process, the Peer Assessor and you will follow a checklist to examine client records to determine if you have met the standards for record keeping. This part of the assessment will provide you with immediate insights into your record keeping skills.

H) FINDING OUT THE RESULTS OF YOUR PRACTICE ASSESSMENT

After your assessment, you will receive a Competency Evaluation Report. The Peer Assessor writes this report, and it is available about two weeks after the assessment.

The Competency Evaluation ReportThe Report will be available in the Portal under the Step 2 Menu tab. An email alert will be sent to you when the report is available for your review on the website. A hard copy report will also be sent to you by courier. You have 14 days to send a written submission in response to the Competency Evaluation Report and your Multi-source Feedback Survey Results to the QA Committee offering additional information that was not communicated during the assessment.

To submit a response using the QA Online Delivery System:1. Click on the Step 2 Menu tab.

2. Click on the “written submission” tab located at the top of the screen.

3. Click on the “new written submission” link at the bottom of the page

4. Write your response by typing in the window.

5. When done, click on the checkbox that says “My written submission is complete”.

6. If you wish to return to complete the submission at a later time, do not check off the above box, instead

“save” the submission and “exit”.

Once completed, the written submission cannot be changed and a notification will be sent to the College.



What to include in a written submissionYou may wish to include the following in your written submission:

• A Summary of your self-identified strengths and/or learning needs;• Evidence of self-remediation (i.e. correct omission in recording keeping, enhanced knowledge and make changes to practice related to a specific competency);• Any details of implemented changes in your practice, based on feedback received during the Competency Review and Evaluation process; and• Points of clarification and evidence of reflection related to the Multi-source Feedback Survey Report (Performance Assessment Profile) and Competency Evaluation Report.

The Quality Assurance Committee encourages you to submit a written submission as it assists with their delib-erations and decision making process.

I) POTENTIAL OUTCOMES OF YOUR PRACTICE ASSESSMENT

Following the assessment, Registrants may receive recommendations to improve their practice, or be required to participate in a remediation program. If serious competency concerns are identified, the OT may have restrictions placed on his or her practice. The QA Committee has authority in regulation (O. Reg. 226/96 Part VI, 29. (6)) and as defined under the Regulated Health Professions Act, 1991, S.O. 1991, c. 18, Sched. 2, s.s.80.2 (1) to:

1. Take no action. When a Registrant clearly demonstrates practice at or above the standards of the profession, the Committee will not require any further action.2. Make recommendations. When the QA Committee identifies areas where voluntary changes or enhancements are sufficient to meet and demonstrate the standards of the profession, the Committee provides specific recommendations.3. Directions remediation. When the QA Committee identifies insufficient knowledge, unsatisfactory skills or judgment that can be addressed through a remediation program, the Registrant is required to participate in Competency Improvement. Competency Improvement may involve completing a learning module and/or PREP Module, self-reflection exercise, courses, and/or learning contract with the support of a practice supervisor. The Registrant may also be required to complete a second peer and/or practice assessment.4. Impose terms, limitations and conditions. When the QA Committee identifies insufficient knowledge, unsatisfactory skills or judgment that must be stopped or restricted due to a significant, immediate risk to the public, the Committee may put terms, limitations or conditions on a Registrant’s certificate. Examples of restrictions include requiring supervision to perform specific tasks, or requiring the OT to remain in the same area of practice until improvement is demonstrated. Registrants will simultaneously engage in a remediation program.5. Refer the Registrant to the Inquires, Complaints and Reports Committee. When the QA Committee has reason to believe that the Registrant may be incompetent, unfit to practise or engaging in professional misconduct, it can make a referral to the Inquires, Complaints and Reports (ICR). Only the Registrant’s name and the reason for referral are given. The ICR Committee undertakes its own inquiries.



Notice of Intent to Make a DecisionThe QA Committee decides the outcome of the assessment, and you will receive its decision about 30 days after the Committee has met. If the QA Committee proposes directed remediation, a “Notice of Intent to Make aDirection” will be sent to you. You have 14 days to send a written submission to the QA Committee indicating that you agree or disagree with the QA Committee’s decision and proposed directed remediation.

Final QA Committee decisionYou will receive the Committee’s final decision when the Committee has agreed to either “take no action” or make “recommendations”. A final decision will also be sent following the Committee reviews of your response to the “Notice or Intent to Make a Direction” or if you choose not to respond to the Notice of Intent to Make a Direction. You can expect the final decision about four to six weeks after your case has been reviewed by the QA Committee. Delays may occur, though, due to scheduling challenges with the Quality Assurance Committee. Additional time may also be needed if the QA Committee requires further information or requires the Registrant to participate in Competency Improvement.

COLLEGE CONTACT INFORMATION

For more information on Step 2 of the Competency Review and Evaluation process, please contact a QualityPrograms staff member at the College.

Manager, Quality ProgramsTel.: 416-214-1177, ext. 227Toll-free: 1-800-890-6570, ext. 227Email: [email protected]

Quality Programs AssociateTel.: 416-214-1177, ext. 239Toll-free: 1-800-890-6570, ext. 239Email: [email protected]

College of Occupational Therapists of Ontario20 Bay Street, Suite 900P.O. Box 78, Toronto, ON M5J 2N8Phone: 416-214-1177Toll-free: 1-800-890-6570Fax: 416-214 -1173



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53032

Access to Client Information and Records

This Occupational Therapist (OT) has been selected to participate in Competency Review and Evaluation, a component of the College of Occupational Therapists of Ontario’sQuality Assurance Program. Competency Review and Evaluation is a process designed to collect information about the therapist’s practice and assess their knowledge, skill and judgment. It also provides feedback to the therapist to encourage practice improvement. Competency Review and Evaluation is a regular Quality Assurance activity and the College’s goal is to have each occupational therapist participate in the process approximately once every five years.

The practice assessment is one step of this process, which involves the review of the therapist’s client records. To facilitate the assessment the occupational therapist is asked to have available, on the day of the assessment ten (10) client records for clients who have been discharged from their OT service. These records will be reviewed by a College Peer Assessor. All information collected and results of the assessment is kept confidential between the College’s Quality Assurance program and the occupational therapist.

One of the questions that therapists and employers may have is whether the occupational therapist can access clients’ records if they are no longer providing service or no longer an employee of the facility/agency. It is the College’s position that under the HealthProfessions Procedural Code made under the Regulated Health Professions Act, 1991(RPHA), ss. 82. (1)(c) the College does have the authority to request access to personal information for the purpose of conducting an assessment and gathering information about the occupational therapist’s care of patients. Under ss. 82(2) and 82(3) of the Code facility operators and health information custodians are required to provide access to premises and charts. This section applies despite any provision in any Act relating to confidentiality of health records [(Code), ss.82 (5)]. Further, the Personal Health Information Protection Act, 2004 (PHIPA), clause.9(2)(e) supports the College’sright of access and states that PHIPA is not to be construed to interfere with the regulatory activities of the College under the RPHA.

The College encourages OTs to follow the applicable policies set out by their practice setting to facilitate access to the client records. For example, where the practice setting requires notification of an employer before client charts are accessed for non-treatment purposes the College would encourage OTs to do so.

If it still unclear as to the duty to cooperate we encourage health care custodians (employers) to speak with their lawyer and/or contact the Manager of the Quality Assurance Program at 416-214-1177 / 1-800- 890-6570 ext. 227 at the College of Occupational Therapist of Ontario.

Sample



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59473

Request for Deferral Competency Review and Evaluation

The College may grant a deferral to participants of Competency Review and Evaluation upon written request. The reason for the deferral should meet specific criteria and each request is considered individually. Please complete, sign and date the form below. Return by the due date via mail or fax to:

Manager, Quality Assurance Program The College of Occupational Therapists of Ontario

20 Bay Street, Suite 900 P.O. Box 78, Toronto, ON M5J 2N8

Phone: (416) 214-1177 / Toll Free: 1(800) 890-6570 EXT 239 Fax number: (416) 214 -1173

----------------------------------------------------------------------------------------------------------

Name: ________________________________ Registration #:___________________ Tel: ________________________________

Check the appropriate box indicating your reason for your request

Please provide details (include a return to practice date):

_________________________________________________________________________

_________________________________________________________________________

_________________________________________________________________________

_________________________________________________________________________

_________________________________________________________________________

__________________________________ ___________________

Major illness or crisis of self or family member

On leave of absence until_____

On Maternity leave until _______ Not currently practising/working

Other:________________________

Sample



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NOTES



College of Occupational Therapists of Ontario20 Bay Street, Suite 900, PO Box 78, Toronto ON M5J 2N8 Tel: 416-214-1177 Fax: 416-214-0851 email: [email protected] www.coto.org

Documents

COMPETENCY REVIEW AND EVALUATION GUIDE - …pdp.coto.org/PDP/LMS_Library/Competency_Review_Guide_Step2.pdf · COMPETENCY REVIEW AND EVALUATION GUIDE: STEP 2 ... OTs are encouraged