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Date Submitted: 06/20/2012 05:33 AM

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| Pilot Plan Worksheet |

|Project Name |      | |Project Leader |      |

Objectives of Pilot Study

|Describe the purpose of the pilot study and what conditions and/or performance levels would be considered pilot success. |

|      |

Pilot Study Metrics & Analysis

|Metric |Data Source |Baseline Performance |Target Result for Pilot |Statistical Analysis to |

| | | |Study |Perform |

|      |      |      |      |      |

|      |      |      |      |      |

|      |      |      |      |      |

|      |      |      |      |      |

Pilot Approach

|Detailed Description of the changes to be tested (refer to attachment if necessary). |

|      |

|Describe how data will be collected during the pilot (hint: a purpose of pilot studies is to learn everything you can about the |

|process; be sure to collect adequate data). |

|     ...