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CAPIZ DOCTORS HOSPITAL

Fuentes Drive, Roxas City


5800 Capiz, Philippines
Tel. No. (036) 6215-675
Fax No. (036) 6215-673

PHILHEALTH ACCREDITED

PERSONNEL PERFORMANCE EVALUATION


Name: ___________________________________ Dept. _______________ Designation: __________________
DIRECTION:
Please give your HONEST and FAIR opinion of the person by rating him/her as follows:
Kindly encircle the appropriate number at the right.
5 outstanding
4 very satisfactory
3 satisfactory
2 unsatisfactory
1 poor
A. EFFICIENCY
1. Punctual and regular in reporting to work

1
2. Industrious in carrying out assigned task willingly
1
3. Responsible in carrying out assigned task
1
4. Follows Hospital Rules and Regulations
1
5. Has initiative and resourcefulness in work
1
6. Cooperative and goes out of the way to be helpful
1
7. Accurate and thorough in work
1
B. EFFECTIVENESS
8. Has a clear understanding and thorough knowledge of work
1
9. Willing to learn and accept changes with ease
1
10. Manifest loyalty to the institution and is concern for its welfare
1
11. Accepts supervision and cooperates with supervisors
1
12. Willing to learn and do more than what is required
1
13. Friendly and respectful towards superiors, patients, their workers
and fellow employees, and shows interest in their welfare
1
14. Considerate towards fellow workers
C. PERSONALITY AND CHARACTER

15. Mature and emotionally stable

1
16. Possesses good physical health
1
17. Neat and clean in person

18. Lives a life consistent with Christian Values and principles


1
19. Maintain personal discipline and proper decorum
1
20. Manifest honestly in dealing with superiors and fellow workers
1

D. REMARKS
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
RATER: ______________________________________
DESIGNATION: ________________________________

DATE: ____________________________

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