PERFORMANCE EVALUATION FORM

For the rating period July to December , 2013

EMPLOYEE : MICHELLE G. OLIMBA

OFFICE/DIVISION: OFFICE OF THE REGIONAL DIRECTOR (STO)

POSITION : Planning Assistant

PART I : PERFORMANCE (70%)
Weight
Alloc.
Work-KRA/Activity
(%)
20% 1. ME3-CHD Scorecard
5% 1.1. Prepares Analysis of CHD Scorecard report

UNIT

5%

1.2. Presents CHD Scorecard report with analysis

(thru various means, i.e., Mancom, RICT and PIRs)

10% 1.3. Prepares /coordinates all the required validation

tools from concerned program managers
20% 2. ME3-LGU Scorecard
10% 2.1Prepares Regional CY 2012 LGU Scorecard Report
based on DILG-LGPMS Report by Province.
5%

2.2Prepares analysis of 2012 LGU SC Report..

5%

2.3 Disseminates / Provides feedback re: LGU SC

report (thru RICT, Health Summits, etc.)

60% 3. Acts as Planning Assistant

10% 3.1 Assists in the conduct of Agency Performance
Reviews (APRs)
10% 3.2 Assists in the preparation of APR quarterly reports

5%

3.3Assists in the preparation of BUB

Unit of Measure /
Indicator

QN-# of analysis
QL-% acceptability
T- # of days / analysis
QN-# of reports presented
QL-% completeness / accuracy
T-as scheduled
QN-# of validation tools collected
QL-% completeness / accuracy
T- # of days / tool
QN-# of LGU Scorecard report
QL-% acceptability
T- # of days / report
QN-# of analysis
QL-% acceptability
T- # of days / analysis
QN-# of feesback provided
QL-% completeness / accuracy
T- as scheduled
QN-# of APR Assisted
QL-% acceptability
T-# of days/ review
QN-# of reports prepared
QL-% acceptability
T-# of days/ report
QN-# of reports prepared

QUANTITY (QN)
Targets

: Planning Unit

QUALITY (QL)

Accomp. Targets Accomp.

TIME (T)

RATING

Targets

Accomp.

QN

SUPERVISOR
QL
T
APS

EPS

QN

EMPLOYEE
QL
T APS

90%

97%

3 days/
analysis

2 days/
analysis

10

8.33

0.42

10

8.33

90%

97%

as scheduled

as scheduled

10

9.50

0.48

10

9.50

All

All

90%

97%

1 week

2 days

10

9.50

0.95

10

9.50

1 reg'l. report
2
90%
98%
(including LGU report in SLA)

2 weeks

3 days

10

10

9.67

0.97

10

10

9.67

10

9.00

0.45

10

10

9.67

10.00 0.50

90%

97%

1 week

1 day

ANA

90%

98%

as scheduled

as scheduled

10

90%

98%

July 23-25

July 23-25, Oct.16

10

10

10

10.00 1.00

10

10

10

9.67

90%

98%

10

9.00

0.90

10

10

8.67

90%

97%

2nd week of July 2nd week of July 8

& October 2nd week October
4th week November
4th week of July 4th week of July
6

7.50

0.38

7.00

9.50

Progress Report.
5%

QL-% acceptability
T-# of days/ report

3.4 Assists in the monitoring of ETS.

QN- # of plans monitored

QL-% completeness / accuracy

& October
6

90%

97%

All

All

90%

98%

3rd week Sept.

As they come

75

90%

99%

As they come

31

90%

98%

& October
6

7.50

0.38

1st week August

10

9.50

0.95

July-December

July-December

10

10.00 1.00

July-December

July-December

9.00

end of each month end of each month

7.50

10

9.50

10

10.00

9.00

T-# of days/ report

10% 3.5 Prepares documents for budget hearing
(for 2014 Budget Proposal)

QN- # of documents prepared

QL-% completeness/acceptability

T-# of days/ document

10% 3.6 Performs other function as may assigned by immediate
supervisor & ARD (i.e., preparation of communications,
memoranda, etc.)
10% 3.7 Attends to various seminars, meetings, workshops
(relative to ME3 & Planning)
100%

QN- #of memo/comm. Prepared

QL-% acceptable feedback

T- as needed
QN- #of trgs. Attended

QL-% acceptable feedback

T- as scheduled
Total Equivalent Point Score (EPS)
Multiply by Percentage Weight Allocation (70%)
Weighted Average Score (WAS)

DISCUSS AND AGREE ON THE ABOVE TARGETS :

DENICE U. PAGUIRIGAN, MPP.

Rater

0.90

MICHELLE G. OLIMBA,RN.
Ratee

12-Dec-13
Date

27

Legend
QN
QL
T
APS
EPS

:
-

PERC Action:
Quantity
Quality
Time
Ave. Point Score
Equivalent Point Score

9.26
6.48

E EVALUATION FORM
July to December , 2013

RATING
EMPLOYEE
EPS
0.42

0.48

0.95

0.97

0.48

0.48

0.97

0.87

0.35

0.38

0.95

1.00

0.90

9.20
6.44

PART II. CRITICAL FACTORS (30%)

Behavioral Factors

Self Rating (10%)

Supervisor Rating (70%)

10
10
10
10
10
10
8

10
10
10
10
10
10
8

68
7
9.71

68
7
9.71

1. COURTESY
2. HUMAN RELATIONS
3. INTEGRITY
4. STRESS TOLERANCE
5. INITIATIVE / RESOURCEFULLNESS
6. COMPLIANCE TO OFFICE RULES AND REGULATIONS
7. PUNCTUALITY AND ATTENDANCE
8. LEADERSHIP ( for supervisors only )
9. JUDGEMENT / DECISION MAKING ( for supervisors only )
Total Point Score
Divide by number of entries
Average Point Score (APS)
COMMENTS AND RECOMMENDATIONS BY THE IMMEDIATE SUPERVISOR
Strong Point

RATER

Supervisor Rater
Self - Rater
Subordinate
Peer Rater
Total Weighted Average Score (TWAS)
Total Weighted Average Score (TWAS) (Part I)
Total Overall Score (TWAS Part I + TWAS Part II)
Add : Intervening Task ( If any )
Final Numerical Rating
Adjectival Rating

DENICE U. PAGUIRIGAN, MPP.

Planning Officer III
Rater
PERC Action (Please encircle) Approval / Disapproval

Subordinate Rating (10%)

S1

S2

Weak Point

Weighted Ave.
Score (WAS)
(Part I)
6.48
6.44
-

Peer Rating (10%)

Total (Sub)

P1
10
10
10
10
10
10
10

P2
10
10
10
10
10
10
10

P3
10
10
10
10
10
10
10

70
7
10.00

70
7
10.00

70
7
10.00

30.00
30.00
30.00
30.00
30.00
30.00
30.00
0.00
0.00
210.00
21
10.00

Recommendations

SUMMARY OF RATINGS
Percentage Weight Allocation
Total Weighted
With
Without
Ave.Score (TWAS)
Subordinate
Subordinate
(Part I)
65%
4.21
35%
2.25
-

Weighted Ave.
Score (WAS)
(Part II)
9.71
9.71
0.00
10.00

Percentage Weight Allocation

With
Without
Subordinate Subordinate
70%
15%
15%

6.47
6.47
9.39

Total (Peers)

Total Weighted Average Score (TWAS) x 30% (Part II)

Total Weighted Ave.

Score (TWAS)
(Part II)
6.80
1.46
1.50
9.75
9.75 X 0.30 =

Very Satisfactory

MICHELLE G. OLIMBA, R.N.

Planning Assistant
Ratee

CORAZON I. FLORES, MD.,MPH, CESE

OIC- Director III
Confirm by Next Higher

Dec. 12, 2013

Date

Supervisor
PERC Chairman

2.93

PERFORMANCE EVALUATION FORM

For the rating period JULY to DECEMBER, 2015
EMPLOYEE: ___________________________________
LEAH M. SUBELDIA

PROVINCE:

QUEZON

POSITION:
PART I :
Weight
Alloc.
(%)

MUNICIPALITY:

TIAONG

10%

10%

10%

NDP
PERFORMANCE (70%)
Unit of Measure /
Indicator

Work-KRA/Activity

A. Assists in the implementation of various health programs

of the Local Gov't Unit in accordance with the program goals
and objectives of the DOH and the health sector
A.1 Attendance to pre-natal visits
QN-# of pre-natal visits attended
QL-% accuracy (effectivity,safeness)
T- w/in 6 months
A. 2 Attendance to post-natal care
QN-# of post-natal visits attended
QL-% accuracy (effectivity,safeness)
T- w/in 6 months
A. 3 Participate in EPI

QN-# of children vaccinated (0-11 months old)

QL-% of effectivity

QUANTITY (QN)
Targets Accomp.

QUALITY (QL)

TIME (T)

Targets

Accomp.

Targets

Accomp.

QN

RATING
SUPERVISOR
QL
T APS EPS QN

EMPLOYE
QL T

71

95

96%

97%

10

10

8.67

0.87

10

10

17

25

96%

96%

10

8.33

0.83

10

56

75

91%

95%

10

8.33

0.83

10

15

20

91%

95%

10

8.33

0.8

10

13

20

91%

95%

0.8

T- w/in 6 months

10%

10%

QN-# of Health Education/Advocacy Conducted

A. 4 Conduct Health Program Education / Advocacy
(Breastfeeding, Family Planning, Healthy Lifestyle, STI-HIV/AIDS)
QL-% effectivity
T- w/in 6 months
A. 5 Number of presumptive TB cases identified
QN-# of presumptiveTB cases identified
QL-% effectiveness
T- w/in 6 months

5%

A. 6 Number of 25 years old and above screened for Non Com

Diseases (HPN)

5%

B. Recording and reporting (FHSIS and other health

programs)
B1. Records and reports of services per program

5%

QL-% accuracy
T- w/in 6 months

Qty: # of records and reports of services per program

Qlty: Completeness of data
Time: w/in 6 months

91%

95%

10

8.33

0.42

10

B2. Performs monthly analysis of FHSIS submitted reports

Qty: No. of health programs reports analyzed

Qlty: Acceptability and completeness
Time: within 6 months

96%

96%

10

10

8.67

0.43

10

10

2%

B3. Referrals made for further management.

Qty: No. of referrals made

Qlty: Completeness
Time: w/in 6 months

13

20

96%

97%

10

8.33

0.17

10

2%

E.2 Monitors and follow up the outcome of referrals

Qty: No. of referrals monitored and followed up

Qlty: Accuracy
Time: w/in 6 months

10

15

96%

96%

10

8.33

0.17

10

4%

C. Assists/Reports in disease surveillance/ emergencies and

disasters/unusual events/notifiable deseases(zero reporting)

10

15

91%

95%

0.32

10%

E.1 Track and follow up EPI, FP and MNCHN defaulters.

19

25

91%

95%

10

8.33

0.8

10

G. Assists in supply management

Qty: No. of assistance provided

Qlty: % effectiveness / acceptability
Time: w/in 6 months
Qty: No. of defaulter tracing and follow ups done
Qlty: Effectiveness
Time: w/in 6 months

5%

G.1 Conduct inventory of FP commodities, drugs, vaccines and

other resources

Qty: No. of times inventory done

Qlty: % effectiveness

96%

97%

10

10

8.67

0.43

10

10

96%

98%

0.3

11

15

91%

95%

10

8.33

0.58

10

Time: w/in 6 months

5%

F. Timely submission of monthly accomplishment reports, DTR

and other reports as required to include incidental reports to the
RO IV-A

Qty: No. of submitted reports

Qlty: % Completeness and acceptability
Time: w/in 6 months

7%

I. Perform other related functions in accordance with NDP AO,

SBI, Kilatis Kutis, provision of technical assistance to CHT
members and partners etc.

Qty: No. of activity conducted

Qlty: % effectiveness/acceptability
Time: w/in 6 months

105%
Total Equivalent Point Score (EPS)
Multiply by Percentage Weight Allocation (70%)
Weighted Average Score (WAS)
DISCUSS AND AGREE ON THE ABOVE TARGETS :

MARIA VICTORIA M. PALICPIC, RN

Rater

LEAH M. SUBELDIA, RN
Ratee

1-Jul-15
Date

Legend :
QN
QL
T
APS
EPS

8.20
x70%
5.74
PERC Action:

Quantity
Quality
Time
Ave. Point Score
Equivalent Point Score

EVALUATION FORM
JULY to DECEMBER, 2015

RATING
EMPLOYEE
APS EPS

8.67 0.87

0.8

8.33 0.83

8.33

0.8

7.67 0.77

0.4

8.67 0.43

8.33 0.17

8.33 0.17

0.32

8.33

0.8

8.67 0.43

0.3

8.33 0.58

8.12
x70%
5.68

PART II. CRITICAL FACTORS (30%)

Behavioral Factors

Supervisor Rating (70%)

10
10
10
10
10
10
10

8
8
6
6
6
6
6

P1
10
10
10
10
10
10
10

70
7
10.00

46
7
6.57

70
7
10.00

1. COURTESY
2. HUMAN RELATIONS
3. INTEGRITY
4. STRESS TOLERANCE
5. INITIATIVE / RESOURCEFULLNESS
6. COMPLIANCE TO OFFICE RULES AND REGULATIONS
7. PUNCTUALITY AND ATTENDANCE
8. LEADERSHIP ( for supervisors only )
9. JUDGEMENT / DECISION MAKING ( for supervisors only )
Total Point Score
Divide by number of entries
Average Point Score (APS)
COMMENTS AND RECOMMENDATIONS BY THE IMMEDIATE SUPERVISOR
Strong Point

RATER

Supervisor Rater
Self - Rater
Subordinate
Peer Rater

Subordinate Rating (10%)

S1
S2
Total (Sub)

Self Rating (10%)

Weak Point

Weighted Ave.
Score (WAS)
(Part I)
5.70
5.70
-

Weighted Ave.
Score (WAS)
(Part II)
6.57
10.00
10.00

Total Weighted Average Score (TWAS) (Part I)

Total Overall Score (TWAS Part I + TWAS Part II)
Add : Intervening Task ( If any )
Final Numerical Rating
Adjectival Rating

Percentage Weight Allocation

With
Without
Subordinate Subordinate
70%
15%
15%

5.70
5.70
2.28

70
7
10.00

70
7
10.00

Total Weighted Ave.

Score (TWAS)
(Part II)
4.60
1.50
1.50
7.60

Total Weighted Average Score (TWAS) x 30% (Part II)

7.6X30% = 2.28

8.00
Very Satisfactory
14-Dec-15

MARIA VICTORIA M. PALICPIC

Rater

HANAH GRACE R. ALVAREZ

Ratee

210.00
21
10.00

Recommendations

SUMMARY OF RATINGS
Percentage Weight Allocation
Total Weighted
With
Without
Ave.Score (TWAS)
Subordinate
Subordinate
(Part I)
65%
3.71
35%
2.00
-

Total Weighted Average Score (TWAS)

Peer Rating (10%)

P2
P3
Total (Peers)
10
10
30.00
10
10
30.00
10
10
30.00
10
10
30.00
10
10
30.00
10
10
30.00
10
10
30.00

Date

Confirm by Next Higher

PERC Action (Please encircle) Approval / Disapproval

Supervisor

PERC Chairman