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Office Performance Output Table

OASPER
January - December 2013

STRATEGIC PRIORITY
MFO / KDP Measures Targets Success Indicators Accountable Division
KDP: Defense Resource Management System, Defense System of Management
Quantity 1 HR / CD Plan developed 1 HR / CD Plan completed before the start of
DND Proper HR / CD Plan Timeliness completed before the start of the calendar year the calendar year with 100% acceptability HRDD
Quality 100% acceptability upon 3 presentations upon 3 presentations
Quantity 1 APB developed 1 APB developed within prescribed
OASPER APB Timeliness within prescribed timeframe timeframe with 100% acceptability upon 3 HRDD
Quality 100% acceptability upon 3 presentations presentations

CORE FUNCTION
MFO / KDP Measures Targets Success Indicators Accountable Division
MFO 1: Human Resource / Career Development Interventions
Quantity 1 approved training calendar per year
1 approved training calendar per year to be
Annual Training Calendar Timeliness completed before the start of every calendar year completed before the start of every CY and HRDD
90% achievable and workable
Quality 90% achievable and workable as perceived by clients
Quantity 1 approved list of foreign and local training programs 1 approved list of foreign and local training
List of Foreign and Local Training programs to be completed before the start of
Timeliness completed before the start of every calendar year HRDD
Programs every CY and 90% responsive to DND HRD
Quality 90% responsive to DND HRD needs as perceived by clients needs
Quantity 17 approved training designs
17 training designs approved upon 2
completed within 3 days for simple and 5 days for complex presentations for simple and 4 for complex
Training Designs Timeliness HRDD
designs
designs to be completed within 3 days for
upon 2 presentations for simple and 4 presentations for simple and 5 days for complex designs
Quality
complex designs
Quantity 33 trainings conducted
33 trainings conducted and accomplished
Trainings Conducted Timeliness accomplished within the approved training calendar within the approved training calendar with HRDD
90% training requirements achieved
Quality 90% training requirements achieved
Quantity 100% of local and foreign travel assisted 100% of local and foreign travels assisted
Timeliness within 1 day for urgent / priority and 3 days for regular within 1 day for urgent / priority and 3 days
Local and Foreign Travels Assisted for regular approved upon 2 presentations HRDD
upon 2 presentations for urgent / priority and 3 presentations for urgent / priority and 3 presentations for
Quality regular
for regular
MFO 2: Human Resource Management Interventions
Quantity 100% of required personnel actions undertaken undertaken 100% of required personnel
Civilian Personnel Actions Timeliness within set deadline actions within set deadline and prescribed CPD
Quality within prescribed quality quality
Quantity 100% of documents acted upon 100% of documents acted upon within 3
Timeliness within 3 days for priority and 5 days for regular documents days for priority and 5 days for regular
Military Personnel Actions MPD
within 3 allowable revisions for both priority and regular documents with 3 allowable revisions for
Quality both priority and regular documents
documents

MFO 3: HR Policy / Program Design Implementation, Monitoring, and Evaluation
Quantity 90% of personnel data inputted and 100% updated 90% of personnel data inputted and 100%
HR Information System Timeliness inputted within 2 days upon receipt of data updated within 2 days upon receipt of data CPD
Quality within 5% allowable error rate with 5% allowable error rate
MFO 4: HR Policy Review and Reformulation
Quantity 1 handbook drafted 1 handbook drafted within the prescribed
Handbook on Military HR Laws and
Timeliness within the prescribed timeline timeline with 100% acceptability upon 3 MPD
Policies
Quality 100% acceptability upon 3 presentations presentations
Quantity updated IPPMS guidelines approved updated IPPMS guidelines approved within
Updated IPPMS Timeliness within set deadline set deadline with 100% acceptability upon 3 CPD
Quality 100% acceptability upon 3 presentations presentations

Quantity 3 Integrity Development Policies developed 3 Integrity Development Policies developed
Integrity Development Policies Timeliness within the prescribed timeline within the prescribed timeline with 100% CPD
acceptability upon 3 presentations
Quality 100% acceptability upon 3 presentations
Quantity 5 GAD Policies developed 5 GAD Policies developed within the
GAD Policies Timeliness within the prescribed timeline prescribed timeline with 100% acceptability
Quality 100% acceptability upon 3 presentations upon 3 presentations
Quantity 2 KAPAGDAKA Policies developed 2 KAPAGDAKA Policies developed within
KAPAGDAKA Policies Timeliness within the prescribed timeline the prescribed timeline with 100% MPD
Quality 100% acceptability upon 3 presentations acceptability upon 3 presentations
Quantity updated Citizen's Charter approved updated Citizen's Charter approved within
Updated Citizen's Charter Timeliness within set deadline set deadline with 100% acceptability upon 3 CPD
Quality 100% acceptability upon 3 presentations presentations
Quantity 1 HR Plan developed 1 HR Plan completed within the prescribed
HR Plan Timeliness within the prescribed timeline timeline with 100% acceptability upon 3 CPD
Quality 100% acceptability upon 3 presentations presentations
Quantity updated GIP / OJT guidelines approved updated GIP / OJT guidelines approved
Updated GIP / OJT Guidelines Timeliness within set deadline within set deadline with 100% acceptability HRDD
Quality 100% acceptability upon 3 presentations upon 3 presentations

SUPPORT FUNCTION
MFO / KDP Measures Targets Success Indicators Accountable Division
MFO 5: Admin and Support Services
Quantity 1 Document Tracking System designed 1 Document Tracking System designed
Document Tracking System Design Timeliness within set deadline within set deadline with 90% responsiveness OD
Quality 90% responsiveness to clients' needs to clients' needs
Quantity 100% requested supplies delivered 100% requested supplies delivered within 2
Office Supplies Management Timeliness within 2 days upon request days upon request with 90% acceptability of OD
Quality 90% acceptability of supplies delivered supplies delivered

Quantity 100% budgeting and financial requirements acted upon 100% budgeting and financial requirements
Office Financial Services Timeliness within set deadline acted upon within set deadline with 100% OD
acceptablity upon 2 revisions
Quality 100% acceptability upon 2 revisions
Quantity 100% of requested transport needs supplied 100% of requested transport needs supplied
Office Transport Operations OD
Timeliness within specified timeframe upon request
within specified timeframe upon request

(FORM B)

OFFICE PERFORMANCE COMMITMENT AND REVIEW (OPCR)
I, COLONEL MARIA VICTORIA P JUAN NC (GSC), Chief Nursing Service Division, VLGH, commit to deliver and agree to be rated on the attainment of the following targets in accordance
with the indicated measures for the period 01 July to 31 December, 2015.
COLONEL MARIA VICTORIA P JUAN NC (GSC)
Head of Office
Date:

Reviewed by Date Confirmed by Date

LTC ANTONIO G PUNZALAN MC (GSC) COLONEL EDWIN LEO T TORRELAVEGA MC (GSC)
Executive Officer, VLGH Commanding Officer, VLGH

Approved by* Date

COLONEL SANTIAGO I ENGINCO PA (GSC)
Chief of Staff, AFPMC
5 - Outstanding
4 - Very satisfactory
3 - Satisactory
2 - Unsatisfactory
1- Poor

SUCCESS INDICATORS (TARGETS + Actual Rating
MFO/PAP Allotted Budget Division Accountable Remarks
MEASURES) Accomplishments Ql1 Qn2 T3 A4
STRATEGIC PRIORITY
To provide tertiary health care
5426 patients treated per semester VLGH
services
CORE FUNCTIONS
MFO 1: Quality nursing care 85% Level of Satisfaction of all patients towards nurses
per month NSD
services
SUPPORT FUNCTIONS
MFO 2: Admin and Support Services
70% Average Score from the Level of Satisfaction
Personnel Satisfaction of All Nursing Personnel at the end of the year Clinical Br

70% of all personnel action request accomplished
Personnel Action Request within (3) working days Admin Br

70% of All Personnel appraisal is accomplished and
Personnel Appraisal submitted with 0 errors in format within one month after Admin Br
the rating period

70% of all the Nursing Personnel disciplinary
Personnel Discipline actions monitored and recorded per month Clinical Br

100% of All Issued Supplies for 24 hours are
Sterile Supplies Processing Sterile CSR

100% of all Nursing Personnel's attendance and
Attendance and Punctuality punctuality will be recorded and monitored per Clinical Br
month

90% of approved schedule of ALL clinical areas
Detail Publication distributed (3) days before the end of the month Clinical Br
MFO 3: Education and Training Services
70% of all Nursing Personnel will undergo Skills Education and Training
Competency Report Competency Checklist biannually Br

70% of RN Residents will pass the program
Education and Training
RN-Residency Program requirements prior to completion at the end of the
semester Br

70% of the RLE exposures of nursing students Education and Training
Affiliation are implemented as programmed per semester Br

70% of P2LTs will pass the Course requirements
Education and Training
Mentoring Program prior to program completion after the six month
period Br

70% of students will pass the Course
AFP Nurse Corps Specialty requirements prior to program completion after
Education and Training
Training Course one year period Br

70% of Nursing Personnel should attend at least
Education and Training
Staff Development Program (3) approved nursing service training programs
biannually Br

70% of Clinical Areas satisfactorily presented case Education and Training
Case Study Report studies biannually Br

Nursing Service Education and 70% of the training plans and programs are Education and Training
Training Program conducted and completed annually Br
MFO 4: Quality Assurance and Research Support Service
90% of the Nursing Clinical areas passed the
Nursing Audit Report Nursing Audit at the end of the semester NR&QA

At least 2 policies reviewed, revised, and
Nursing Policies and Procedures formulated with 0 errors in format at the end of the NR&QA
semester

70% of Nursing Personnel satisfactorily passed
Infection Control Domain Audit the Infection Control Domain Audit at the end of HICC
the semester

Integrated Disease Surveillance 70% of the Clinical Areas submits the PIDSR form
on time every week with 0 errors in format HICC
and Response

All sentinel events are Collected, Analyzed, and
Hospital Event Report Reported with 0 errors in format at the end of the NR&QA
semester

70% of Nurses satisfactorily participate in
Evidence-Based research research activities at the end of the semester NR&QA

CORE FUNCTION MFO 1: Quality nursing care services
SUPPORT FUNCTIONS MFO 2: Admin and Support Services
MFO 3: Education and Training Services
MFO 4: Quality Assurance and Research Support Services
TOTAL AVERAGE POINT SCORE
OVERALL EQUIVALENT NUMERICAL RATING
OVERALL EQUIVALENT ADJECTIVAL RATING

Assessed by: Confirmed by: Final Rating by: Date

LTC ANTONIO G PUNZALAN MC (GSC) COL EDWIN LEO T TORRELAVEGA MC (GSC) COLONEL SANTIAGO I ENGINCO PA (GSC)
Ex-O, VLGH CO, VLGH Head of Agency
Date: Date:

Legend: 1 - Quality (Ql) 2 - Quantity (Qn) 3 - Timeliness (T) 4 - Average (A)

SG-15) Mr Claresto Rhuir Bas-awan RN I Staff Nurse I (Nurse I. VLGH Admin and Support Services Mentoring and Training Program Quality Assurance and Research Clinical Care Monthly Report Training Recommendation Environment of Care Checklist Staff Distribution LTC ARLENE V GUTIERREZ NC (GSC) Leave Request Staff Orientation (Newly Hired) Incident Reports Patient Care Supervision Assistant Chief Nurse for Clinical Care Performance Evaluation Ward Activities Monitoring In-patient Census Report Attendance Report Environment of Care Checklist VIP report Notice of Discipline Incident Reports In-patient Census Report Clinical Area Supervisor Performance Evaluation Staff Distribution Supplies and Equipment Management 2LT NOVIE CARLA G PAGADUAN NC Head Nurse Ms Arlene Sales RN II Assistant Head Nurse (Nurse II. SG .11) Ms Yolanda Vasquez NA (Nursing Attendant I. SG-8) .WARD 4 C GENITOURINARY _ _______________July to December 2015_______________ Chief Nurse. SG-15) Ms Jennifer Parajes RN II Case Manager (Nurse II. (FORM C) ROLE-RESULTS MATRIX __NURSING SERVICE DIVISION . SG-8) Ms Mary Rose Regaspi NA (Nursing Attendant I. SG-8) Ms Angeles Lapinig NA (Nursing Attendant I.

Letter of Explanation.25 0.75 0. other rating period the whole rating documents as instructed before period given deadline Performance of Performing duties of a higher position Tasked in Nursing Service or Performing duties of lower Command Directed Program or position Designated Function Activities Tasked as member of Technical Working Group or Committees Performed > 16 hours cumulative Training Instructor and > 8 hours Lecturer duties . MERIT / DEMERIT POINTS CRITERIA MERIT DEMERIT POINTS 0. Submission for the whole to Submission for Incident Reports.10 notices of 5 notices of loafing loafing Disciplinary Offenses 1 Grave and / or 2 less 1 Less Grave 4 Light Offenses with Oral Warning Grave Offenses and / or 9 Offense and / or 6 Light Offenses with a Light Offense with Reprimand or higher Written Warning Disciplinary Action (Admonition) Disciplinary action Non . Nursing Unit Non-compliance to or Non-compliance whole rating period Submission Reports. DTR.5 0.compliance to Submits Leave Application 7 & above notices for Late or 4 .18 tardiness for 9 tardiness for the whole rating period whole rating period the whole rating period 11 & above notices of loafing 6 .6 unauthorized or 3 unauthorized or uninformed absence (3 hours before duty) absence with no unauthorized per month for 3 uninformed absence hours before duty) Punctuality tardiness and no notices loafing for consecutive months or 3 (3 hours before duty) the whole rating period months per rating period.75 0.6 notices for Late 3 notices for Late Submission for the requests. 6 uninformed (3 hours before duty) or unauthorized absence for the whole rating period 19 & above tardiness for the 12 .1 authorized and informed (3 > 3 authorized or 4 .25 Attendance / 0 .5 0.

with 61-70 minutes. Endorsement Book Quality with complete details 100% of patients. discharge with 3-5 errors Quantity all patients error. 3 errors. 0 error. with 2-3 errors. within Timeliness completed within shift all patients within shift shift with 0 (zero) error. Incomplete requirements. 10. missed data Complete requirements. or with 2-3 81-90 minutes. or with 4-5 >90 minutes. missed data. with 0-1 Quality Incomplete requirements. or with 6 or first hour of the shift Quantity all patients 0 (zero) missed data.100% delegated tasks more 100% delegated tasks 100% delegated tasks 100% delegated tasks 100% delegated tasks Performs all administrative tasks as directed and as 48 hours after deadline than 49 hours beyond Timeliness upon deadline upon deadline with 0 upon deadline with 0 upon deadline with 1-2 upon deadline with 3-4 delegated by the Head Nurse and /or with 5-6 deadline and/or with more (zero) uncomplied tasks (zero) uncomplied tasks uncomplied tasks uncomplied tasks Quantity all delegated tasks uncomplied tasks than 7 uncomplied tasks . on or sufficient substance but 1. Nursing Care Plan Quality No error <100% of patients more <100% of patients more than Completed Nursing Care Plan of all patients within 100% of patients within 24 100% of patients within 24 100% of patients within 24 100% of patients within 48 Timeliness completed within 24 Hours than 48 hours or with 4-5 48 hours or with 6 or more 24 hours hours with 0 (zero) error.Infectious Ward (Medical)_______ PERFORMANCE SUCCESS INDICATOR PERFORMANCE STANDARDS Major Final Outputs PERFORMANCE TARGETS Outstanding Very Satisfactory Satisfactory Unsatisfactory Poor MEASURES Measures + Targets 1. shift with 1 error. within 100% of patients. within 100% of patients. shift. 0 (zero) error. on or Excellent substance. shift with 4-5 errors shift with 6 or more errors Quantity all patients 6. hours or with 2-3 errors. error. and/or 2-3 missed data. within <100% of patients. with 0 (zero) error with 1 eror. sufficient substance but and/or 49-72 hours after and/or more than 72 hours paper biannually before deadline with 0-1 before deadline with 0-1 24 hours after deadline 25-48 hours after deadline deadline and/or 6-7 after deadline and/or more Quantity Complete requirements missed data. shift or with 2 errors. 2. with 1 error. error. 1 error. Case Study/Research Paper excellent substance. Health Teaching Record Quality No error 100% of patients upond 100% of patients upon <100% of patients. or with 1 71-80 minutes. shift or with 3 errors or with 4 or more errors Quantity all patients 5. with 0 (zero) error. Complete requirements. shift with 3-5 errors with 6 or more errors Quantity all patients 9. insufficient substance unacceptable substance Completed requirements for case study/ research Timeliness On or before deadline Excellent substance. missed data. shift with 3-5 error with 6 or more errors Quantity all patients 8. Complete requirements. errors. than 8 missed data 11. hours with 0 (zero) error. Emergency Cart Equipment Record Quality No error 100% of Emergency Cart 100% of Emergency Cart 100% of Emergency Cart 100% of Emergency Cart <100% of Emergency Cart Complete accounting of Emergency Cart Equipment <100% of patients within shift Timeliness within shift Equipment within shift Equipment within shift with Equipment within shift with Equipment within shift Equipment within shift with within shift with 6 or more errors Quantity all E-cart equipments with 0 (zero) error. upon Completed Health Teaching Protocol of all patients 100% of patients upon 100% of patients upon <100% of patients upon Timeliness completed upon discharge discharge with 0 (zero) discharge with 0 (zero) discharge with 6 or more upon discharge discharge with 1 error. errors 7. shift with 0 (zero) error. Assistive Nurse Manager Deficiency Record Quality All tasks complied 100% delegated tasks 24. Patient Assessment Progress Notes Quality No errors in Standard Protocols <100% of patients more <100% of patients more than Completed Nursing Assessment Protocol of all 100% of patients within 24 100% of patients within 24 100% of patients within 24 100% of patients within 48 Timeliness completed within 24 Hours than 48 hours or with 4-5 48 hours or with 6 or more Patient within 24 hours hours with 0 (zero) error. Nursing Progress Notes Quality No error Completed Nursing Progress Notes of all patients 100% of patient within 100% of patient within shift 100% of patient within shift 100% of patients within <100% of patients within <100% of patients within shift Timeliness within shift within shift shift with 0 (zero) error. hours or with 2-3 errors. discharge with 2 errors. shift with 2 errors. within 100% of patients. Nurse Manager Role Deficiency Checklist Quality All tasks complied <100% nurse manager tasks <100% nurse manager Timeliness upon deadline 100% nurse manager 100% nurse manager 100% nurse manager and/ormore than 49 hours Performs administrative duties and responsibilities in 100% upon deadline with tasks and/or 24-48 hours tasks upon deadline with 0 tasks upon deadline with tasks upon deadline with beyond deadline and/or with the absence / behalf of the Head Nurse 0 (zero) error after deadline and/or with (zero) error 1-2 errors 3-4 errors more than 7 uncomplied Quantity all delegated tasks 5-6 errors tasks 12. Quantity all patients errors errors 4. Complete requirements. within Received all patients with complete details within the Timeliness within first hour of the shift the first hour of shift. Quantity all patients errors errors 3. Individual Work Output Table ____Office of the Nursing Service _____ _____________________________________________ ________Nurse II SG-15 (Assistant Head Nurse)_________ ___________Clinical Care Branch . ISOBAR Defficiency Record Quality No error Completed ISOBAR Standard Protocol of all patients 100% of patient within 100% of patient within shift 100% of patient within shift 100% of patients within <100% of patients within <100% of patients within shift Timeliness within shift within shift shift with 0 (zero) error. hours with 1 error. hours with 1 error. and/or 4-5 missed data. more errors. within <100% of patients. Medication Administration Record Quality No error Completed Medication Protocol of all patients within 100% of patients within 100% of patients within 100% of patients within 100% of patients within <100% of patients within <100% of patients within shift Timeliness completed within shift shift shift with 0 (zero) error. with the first hour of shift. shift with 2 errors. with 2 errors. Nursing Procedures Defficiency Monitoring Record Quality No error Completed Nursing Procedures Standard Protocol of 100% of patients within 100% of patients within 100% of patients within 100% of patients within <100% of patients within <100% of patients. shift with 1 error. shift with 0 (zero) error. hours with 0 (zero) error. errors.

AURORA M DELA CRUZ RN II. upon discharge with (0) zero Health Teaching Record 100% of patients upon discharge with 1 error 4 4 4 4 error Nursing Progress Notes 100% of patients. within the first hour of shift. within shift with 0 (zero) error 100% of patients. _______________________ Employee Date: ___________________ Reviewed by Date Approved by Date CPT KRISTINA L SALVADOR NC LTC CAROLINE D COMMENDADOR NC Immediate Supervisor Head of Office Rating Output Success Indicator (Target + Measure) Actual Accomplishments Remarks Ql1 Qn2 T3 A4 Core Function 100% of patients. within shift with 0 (zero) error 100% of patients. Division of Nursing commit to deliver and agree to be rated on the attainment of the following targets in accordance with the indicated measures for the period from July to December. with 0 missed data / Endorsement Book 3 3 3 3 0 (zero) missed data error Patient Assessment 100% of patients. within 24 hours with 0 (zero) <100% of patients within 24 hours with 5 errors 2 2 2 2 Progress Notes error 100% of patients. within 24 hours with 0 (zero) Adheres to AFPMC Standard 100% of patients within 24 hours with 0 (zero) error 5 5 5 5 Administration Record error Protocols of Safe Medication Administration Nursing Procedures Deficiency Monitoring 100%of patients. MS. within 24 hours with 0 (zero) Nursing Care Plan 100% of patients within 24 hours with 2-3 errors 3 3 3 3 error 10Rs correctly observed and Medication 100% of patients. 2015. (FORM E) INDIVIDUAL PERFORMANCE COMMITMENT AND REVIEW (IPCR) I. with 100% of patients. 100% of patients. of the Infectious Ward. within shift with 0 (zero) error 100% of patients within shift with 2 errors 3 3 3 3 ISOBAR Deficiency Disorganized. within 71-80 mins. within shift with 4-6 errors 2 2 2 2 Record 100% of patients. Incomplete. within shift with 6 errors 1 1 1 1 Record Faulty Relay of Information .

Quantity (Qn) 3 . Excellent substance on or Complete requirements.83 2.Average (A) .83 2. Sufficient substance 25 -48 hours 3 3 3 3 Paper before deadline with 0 (zero) missed data after deadline with 2 missed data Nurse Manager Role 100% nurse manager tasks upon deadline with 0 100% nurse manager tasks upon deadline with 5 errors 2 2 2 2 Deficiency Checklist (zero) error Nurse Manager 100% delegated tasks upon deadline with 0 (zero) 100% delegated tasks upon deadline with 4 uncomplied Assistant Deficiency 3 3 3 3 uncomplied tasks tasks Checklist Average point score 2.83 Intervening point score 0.Quality (Ql) 2 .83 2.Timeliness (T) 4 .08 Overall Equivalent Adjectival Rating Satisfactory Comments and Recommendations for Development Purposes Discussed with Date Assessed by Date Final Rating by Date I certify that I discussed my assessment of the performance with the employee CPT KRISTINA L SALVADOR NC LTC CAROLINE D COMMENDADOR NC Employee Supervisor Head of Office Legend: 1 .25 Overall Equivalent Numerical Rating 3.83 Overall point score 2.Support Function Emergency Cart 100% of Emergency Cart Equipment within shift 100% of Emergency Cart Equipment. within shift with 2 errors 3 3 3 3 Equipment Record with 0 (zero) error Case Study / Research Complete requirements.

Case Study/Research Paper excellent substance. with 0 (zero) error. with 61-70 minutes. errors. 1 error. shift with 1 error. within <100% of patients. shift with 4-5 errors Quantity all patients errors of all patients within shift 6.Female Surgical Ward________ PERFORMANCE SUCCESS INDICATOR PERFORMANCE STANDARDS Major Final Outputs PERFORMANCE TARGETS Outstanding Very Satisfactory Satisfactory Unsatisfactory Poor MEASURES Measures + Targets 1. shift with 2 errors. hours with 0 (zero) error. shift with 0 (zero) error. hours or with 2-3 errors. shift. within complete details Timeliness within first hour of the shift the first hour of shift. Medication Administration Record Completed Quality No error Medication Timeliness completed within shift <100% of patients within 100% of patients within 100% of patients within 100% of patients within 100% of patients within <100% of patients within Protocol of all shift or with 4 or more shift with 0 (zero) error. within 100% of patients. Emergency Cart Equipment Record Quality No error Complete Timeliness within shift accounting of 100% of Emergency Cart 100% of Emergency Cart 100% of Emergency Cart 100% of Emergency Cart <100% of Emergency Cart <100% of patients within Emergency Cart Equipment within shift Equipment within shift with Equipment within shift with Equipment within shift Equipment within shift with shift with 6 or more Equipment within Quantity all E-cart equipments with 0 (zero) error. or with 6 or within the first Quantity all patients 0 (zero) missed data. hours with 1 error. Endorsement Receives all Book patients with Quality with complete details 100% of patients. or with 1 71-80 minutes. requirements for Excellent substance. more errors. or with 4-5 >90 minutes. errors upon discharge 7. discharge with 3-5 errors Quantity all patients error. shift with 1 error. hours or with 2-3 errors. ISOBARshiftDefficiency Record Quality No error Completed Timeliness within shift ISOBAR <100% of patients within 100% of patient within 100% of patient within shift 100% of patient within shift 100% of patients within <100% of patients within Standard Protocol shift with 6 or more shift with 0 (zero) error. error. Quantity all patients errors or more errors Patient within 24 hours 3. hours with 1 error. error. Patient the shift Assessment Progress Notes Completed Quality No errors in Standard Protocols Nursing Timeliness completed within 24 Hours <100% of patients more <100% of patients more Assessment 100% of patients within 24 100% of patients within 24 100% of patients within 24 100% of patients within 48 than 48 hours or with 4-5 than 48 hours or with 6 Protocol of all hours with 0 (zero) error. with 2 errors. with 0 (zero) error. Complete requirements. with 1 error. with 1 error. Incomplete requirements. shift with 3-5 errors patients within Quantity all patients errors 8. shift with 0 (zero) error. errors. shift or with 3 errors patients within Quantity all patients errors shift 5. hour of 2. 3 errors. requirements.unacceptable substance . Complete requirements. Nursing Progress Notes Completed Nursing Progress Quality No error <100% of patients within 100% of patient within 100% of patient within shift 100% of patient within shift 100% of patients within <100% of patients within Notes of all Timeliness within shift shift with 6 or more shift with 0 (zero) error. on or Excellent substance. shift with 2 errors. within 100% of patients. with 0-1 Quality error Incomplete Completed Complete requirements. on or very sufficient substance sufficient substance 25. insufficient substance 49. shift or with 2 errors. errors shift 10. with the first hour of shift. 0 (zero) error. with 2-3 errors. 0 error. Individual Work Output Table ____Office of the Nursing Service _____ _____________________________________________ ________Nurse II SG-15 (Case Manager)_________ ___________Clinical Care Branch . hours with 0 (zero) error. Health Teaching Record Quality No error Completed Health Timeliness completed upon discharge 100% of patients upond 100% of patients upon <100% of patients. within 100% of patients. within Procedures 100% of patients within 100% of patients within 100% of patients within 100% of patients within <100% of patients within shift with 6 or more Standard Protocol shift with 0 (zero) error. shift with 3-5 errors of all patients Quantity all patients errors within shift 9. Nursing Procedures Defficiency Monitoring Record Quality No error Completed Timeliness completed within shift Nursing <100% of patients. discharge with 2 errors. patients within 24 Quantity all patients errors or more errors hours 4. upon Teaching Protocol 100% of patients upon 100% of patients upon <100% of patients upon discharge with 0 (zero) discharge with 0 (zero) discharge with 6 or more of all patients discharge with 1 error. or with 2-3 81-90 minutes. Nursing Care Plan Completed Quality No error Nursing Care Timeliness completed within 24 Hours <100% of patients more <100% of patients more 100% of patients within 24 100% of patients within 24 100% of patients within 24 100% of patients within 48 Plan of all than 48 hours or with 4-5 than 48 hours or with 6 hours with 0 (zero) error. within <100% of patients. Complete requirements.

unacceptable substance case study/ before deadline with 0-1 before deadline with 0-1 1-24 hours after deadline 48 hours after deadline 72 hours after deadline more than 72 hours after research paper error. Incomplete requirements. Complete requirements. on or very sufficient substance sufficient substance 25. Complete requirements. deadline and/ or with biannually Quantity Complete requirements more than 8 errors 11 NCP Template/Clinical Pathway template Formulate/ Quality 0 error in format/substance unacceptable substance Revise/review 4 3 NCP templates 1-24 2 NCP templates 25-48 1 NCP templates 49-72 4 NCP templates within a 4 NCP templates within a more than 72 hours after nursing care plan Timeliness within a month hours after a month and/or hours after a month hours after a month and/or month with 0 error month with 0 error deadline and/or with templates a with 1-2 error and/or with 3-4 error with 5-6 error more than 8 errors month Quantity 4 NCP templates . insufficient substance 49. requirements for Timeliness On or before deadline Excellent substance. Incomplete Completed Complete requirements. and/or with 6-7 errors. and/or with 4-5 errors. on or Excellent substance. Complete requirements. requirements. and/or with 2-3 errors. error.

12. NCP Compliance Checklist checks NCP Quality 0 error compliance of <70% NCP upon Timeliness upon discharge 100% NCP upon 100% NCP upon 90% NCP upon discharge 80% NCP upon discharge 70% NCP upon discharge nurses to all discharge and/or with discharge with 0 error discharge with 0 error and/or with 1-2 errors and/or with 3-4 errors and/or with 5-6 errors patients upon more than 7 errors discharge Quantity all NCP .

2015. (FORM E) INDIVIDUAL PERFORMANCE COMMITMENT AND REVIEW (IPCR) I. within shift with 0 (zero) error 100% of patients. within 24 hours with 0 (zero) Incomplete and unfilled up Nursing Care Plan <100% of patients. within 24 hours with 0 (zero) <100% of patients. AMI M MIZUNO RN II. with 0 error 5 5 5 5 0 (zero) missed data Well organized Patient Assessment 100% of patients. within the first hour of shift. within shift with 1 error 4 4 4 4 Record . within shift. more than 48 hours or with 8 errors 1 1 1 1 error NCP Adheres to the Patient Safety Standards of Medication 100% of patients. within shift with 3 errors 3 3 3 3 Record 100% of patients. within shift with 1 error 4 4 4 4 ISOBAR Deficiency 100% of patients. with Systematically done and Endorsement Book 100% of patients. _______________________ Employee Date: ___________________ Reviewed by Date Approved by Date CPT KARLA MINA N DELA ROSA NC LTC CAROLINE D COMMENDADOR NC Immediate Supervisor Head of Office Rating Output Success Indicator (Target + Measure) Actual Accomplishments Remarks Ql1 Qn2 T3 A4 Core Function 100% of patients. within shift with 0 (zero) error 100% of patients. with 4 errors 2 2 2 2 error Nursing Progress Notes 100% of patients. Division of Nursing commit to deliver and agree to be rated on the attainment of the following targets in accordance with the indicated measures for the period from July to December. more than 48 hours or with 4-5 errors 2 2 2 2 Progress Notes error 100% of patients. within the first hour of shift. within 24 hours with 0 (zero) error 5 5 5 5 Medication Administration Administration Record error and prudently observes the 10Rs Nursing Procedures Deficiency Monitoring 100%of patients. of the Female Surgical Ward. within 24 hours with 0 (zero) 100% of patients. upon discharge with (0) zero Health Teaching Record <100% of patients. within shift with 0 (zero) error 100% of patients. MS.

with 4 2 2 2 2 check the E-Cart stock Equipment Record with 0 (zero) error errors records.08 Overall point score 3.58 Overall Equivalent Adjectival Rating Very Satisfactory Comments and Recommendations for Development Purposes Discussed with Date Assessed by Date Final Rating by Date I certify that I discussed my assessment of the performance with the employee CPT KARLA MINA N DELA ROSA NC LTC CAROLINE D COMMENDADOR NC Employee Supervisor Head of Office Legend: 1 . low on initiative Case Study / Research Complete requirements.50 Overall Equivalent Numerical Rating 3.08 Intervening point score 0. very sufficient substance 5 hours 4 4 4 4 Paper on or before deadline with 0 .1 missed data before deadline with 2 missed data NCP Template / Clinical 4 NCP templates within a month with 0 error 3 NCP templates 5 hours after a month with 1 error 4 4 4 4 Pathway template Insufficient and incomplete NCP Compliance NCPs. Needs improvement 100% NCP upon discharge with 0 error <70 % NCP upon discharge with 10 errors 1 1 1 1 Checklist on systematic time allocation for NCP formulation Average point score 3.08 3.08 3. Excellent substance and Complete requirements.Quality (Ql) 2 .Timeliness (T) 4 .Quantity (Qn) 3 .Support Function Needs to be reminded to Emergency Cart 100% of Emergency Cart Equipment within shift <100% of Emergency Cart equipment within shift.Average (A) .08 3.

Endorsement Book Quality with complete details Receives all patients with 100% of patients. more errors. or with 6 or first hour of the shift data. shift or with 3 errors shift errors Quantity all patients 5. upon 100% of patients upond discharge 100% of patients upon 100% of patients upon <100% of patients upon Protocol of all patients upon discharge with 0 (zero) discharge with 6 or more with 0 (zero) error. on or case study/ research paper substance. Medication Administration Record Quality No error Completed Medication <100% of patients within 100% of patients within shift with 0 100% of patients within 100% of patients within 100% of patients within <100% of patients within Protocol of all patients within Timeliness completed within shift shift or with 4 or more (zero) error. with 0 (zero) error. hours with 1 error. within <100% of patients. errors. discharge with 2 errors. shift with 0 (zero) error. errors. Nursing Care Plan Quality No error Completed Nursing Care 100% of patients within 48 <100% of patients more <100% of patients more 100% of patients within 24 hours 100% of patients within 24 100% of patients within 24 Plan of all patients within 24 hours and/ or with 2-3 than 48 hours and/or with than 48 hours and/or Timeliness completed within 24 Hours with 0 (zero) error. hours with 0 (zero) error. with 2-3 errors. within 100% of patients. shift with 1 error. errors. within complete details within the Timeliness within first hour of the shift hour of shift. discharge with 1 error. errors 7. deadline and/or with 2-3 deadline and/or with 4-5 deadline and/or with 6-7 hours after deadline error. with 0 (zero) error. shift with 3-5 errors patients within shift errors Quantity all patients 9. Patient Assessment Progress Notes Quality No errors in Standard Protocols Completed Nursing <100% of patients more <100% of patients more Timeliness completed within 24 Hours 100% of patients within 24 hours 100% of patients within 24 100% of patients within 24 100% of patients within 48 Assessment Protocol of all than 48 hours or with 4-5 than 48 hours or with 6 with 0 (zero) error. with 0-1 Incomplete Quality error Complete requirements. and/or with 3 errors. shift or with 2 errors. within <100% of patients. shift with 1 error. or with 4-5 >90 minutes. Completed requirements for Complete requirements. hours with 0 (zero) error. with 1 error. shift with 2 errors. with 0 (zero) missed the first hour of shift.Neuro-Surgical Ward (Ward 4A)________ PERFORMANCE STANDARDS PERFORMANCE SUCCESS INDICATOR Measures Major Final Outputs PERFORMANCE TARGETS MEASURES + Targets Outstanding Very Satisfactory Satisfactory Unsatisfactory Poor 1. requirements. Quantity all patients 2. Nursing Procedures Defficiency Monitoring Record Quality No error Completed Nursing Timeliness completed within shift <100% of patients. Complete requirements. 4-5 errors with 6 or more errors Quantity all patients 4. ISOBAR Deficiency Record Quality No error Completed ISOBAR Timeliness within shift <100% of patients within 100% of patient within shift with 0 100% of patient within shift 100% of patient within shift 100% of patients within <100% of patients within Standard Protocol of all shift with 6 or more (zero) error. with 61-70 minutes. Excellent very sufficient substance sufficient substance insufficient substance unacceptable substance Timeliness On or before deadline Excellent substance. within the first 100% of patients. or with 2-3 81-90 minutes. error. Complete requirements. Health Teaching Record Quality No error Completed Health Teaching Timeliness completed upon discharge 100% of patients upon <100% of patients. Individual Work Output Table Nursing Service Division _____________________________________________ ________Nurse I. hours or with 2-3 errors. Patient within 24 hours errors or more errors Quantity all patients 3. or with 1 71-80 minutes. Nursing Progress Notes Quality No error Completed Nursing Progress <100% of patients within 100% of patient within shift with 0 100% of patient within shift 100% of patient within shift 100% of patients within <100% of patients within Notes of all patients within Timeliness within shift shift with 6 or more (zero) error. shift with 0 (zero) error. within Procedures Standard 100% of patients within shift with 0 100% of patients within 100% of patients within 100% of patients within <100% of patients within shift with 6 or more Protocol of all patients within (zero) error. and/or with 1 error. hours errors. and/or with more than 8 Quantity Complete requirements errors . Incomplete requirements. errors. shift. discharge with 3-5 errors discharge Quantity all patients error. and/or with 2 errors. shift with 3-5 errors shift errors Quantity all patients 8. Emergency Cart Equipment Record Quality No error Complete accounting of Timeliness within shift 100% of Emergency Cart 100% of Emergency Cart 100% of Emergency Cart 100% of Emergency Cart <100% of Emergency Cart <100% of patients within Emergency Cart Equipment Equipment within shift with 0 (zero) Equipment within shift with Equipment within shift Equipment within shift Equipment within shift shift and/or with 6 or within shift error. with 1 error. 0 error. 0 (zero) error. hours and/or with 1 error. errors. shift with 2 errors. shift with 4-5 errors errors shift Quantity all patients 6. SG-11_________ ___________Clinical Care Branch . within 100% of patients. Case Study/Research Paper excellent substance. more errors Quantity all E-cart equipments 10. on or before deadline and/or 1-24 hours after and/or 25-48 hours after and/or 49-72 hours after and/or more than 72 before deadline with 0-1 biannually with 0-1 error.

100% of patients within shift with 0 (zero) error. 100% of patients within shift with 1 error. INDIVIDUAL PERFORMANCE COMMITMENT AND REVIEW (IPCR) I. Division of Nursing commit to deliver and agree to be rated on the attainment of the following targets in accordance with the indicated measures for the period July to December. or with no error. upon discharge with 0 (zero) errors 5 5 5 5 Educates eloquently error. 5 5 5 5 Record . 4 4 4 4 ISOBAR Deficiency 100% of patient within shift with 0 (zero) error. Medication 100% of patients within shift with 0 (zero) error. 4 4 4 4 0 (zero) missed data. within 48 hours or with 4 errors 2 2 2 2 Progress Notes error. 100% of patients within shift with 2 errors. 100% of patients within shift with 1 error. within 65 minutes. 5 5 5 5 Procedures prudently Record and competently 100% of patients upond discharge with 0 (zero) Health Teaching Record 100% of patients. within the first hour of shift. _______________________ Employee Date: ___________________ Reviewed by Date Approved by Date CPT FELIX RICHARD I MENDOZA NC MAJ NELSON A MANONDO NC Immediate Supervisor Head of Office Rating Output Success Indicator (Target + Measure) Actual Accomplishments Remarks Ql1 Qn2 T3 A4 Core Function 100% of patients. of the Neuro-Surgical Ward. 2015. Nursing Progress Notes 100% of patient within shift with 0 (zero) error. MS. 4 4 4 4 Administration Record Nurisng Procedures Performs Nursing Deficiency Monitoring 100% of patients within shift with 0 (zero) error. with Endorsement Book 100% of patients. Patient Assessment 100% of patients within 24 hours with 0 (zero) <100% of patients. REI JEAN C DELA PENA RN I.

I have attached a letter of appeal on this matter with substantial evidences to prove the rating Ms otherwise.50 3.Average (A) . 4 4 4 4 error. Incomplete requirements. Rei Jean C Dela Pena RN Discussed with Date Assessed by Date Final Rating by Date I certify that I discussed my assessment of the performance with the employee MS.75 Overall Equivalent Numerical Rating 2. Emergency Cart 100% of Emergency Cart Equipment within shift 100% of Emergency Cart Equipment within shift with 1 4 4 4 4 Equipment Record with 0 (zero) error. on submitted more than 72 hours after deadline with 8 1 1 1 1 Needs Improvement Paper or before deadline with 0-1 error.50 Intervening point score -0.50 Overall point score 3. error. REI JEAN C DELA PENA RN I CPT FELIX RICHARD I MENDOZA NC MAJ NELSON A MANONDO NC Employee Supervisor Head of Office Legend: 1 . unacceptable substance Case Study / Research Complete requirements. errors Average point score 3.55 Overall Equivalent Adjectival Rating Unsatisfactory Comments and Recommendations for Development Purposes I do not conforme with the rating given to me.50 3.50 3.Quality (Ql) 2 .Timeliness (T) 4 .Quantity (Qn) 3 . Excellent substance.Support Function 100% of patients within 24 hours with 0 (zero) Nursing Care Plan 100% of patients within 24 hours with 1 error.

or with 1 error. or with 1 error. the shift or with 4-5 errors. NAP Critical Patient Reporting Deficiency Record Quality accurate 100% of patients. error.COPAR excellent substance. with 2-3 errors. Research / HRDP . within <100% of patients. labor error error more errors. requirements. the shift or with 4-5 errors. within Teaching Protocol Timeliness completed within shift 100% of patients within 100% of patients within 100% of patients within 100% of patients within <100% of patients within shift with 6 or more of all patients upon shift with 0 (zero) error. with zero (0) the shift. EINC Procedure Checklist Deficiency Record Quality No error Completed EINC <100% of patients. shift. shift with 0 (zero) error. 2. Incomplete requirements. within shift 8. within 100% of patients. with 2-3 errors. shift with 1 error. shift with 1 error. within records accurate the shift.Obstetrics and Gynecology Ward________ PERFORMANCE SUCCESS INDICATOR PERFORMANCE STANDARDS Major Final Outputs PERFORMANCE TARGETS MEASURES Measures + Targets Outstanding Very Satisfactory Satisfactory Unsatisfactory Poor 1. within <100% of patients. shift. Midwife Administrative Deficiency Record Quality No error Timeliness completed within shift <100% of patients. or with 1 error. within progress of patient Timeliness within shift the shift. within 100% of patients. shift with 1 error. with zero (0) the shift. Complete requirements. shift. Vital signs/ I&O Monitoring Sheet Quality accurate monitors and Timeliness within shift 100% of patients. biannually errors. errors. error. error. shift with 4-5 errors errors Quantity all patients 9. with zero (0) the shift or with 6 or the shift. shift with 2 errors. within 100% of patients. patient data Quantity all patients error error more errors. within report accurate 100% of patients. shift with 1 error. Quantity all equipment and supply errors. Labor Monitoring Sheet Quality accurate report accurate 100% of patients. error. requirements for Timeliness On or before deadline very sufficient substance sufficient substance insufficient substance unacceptable substance Excellent substance. with zero (0) the shift or with 6 or the shift. within the shift Quantity all assigned areas 7. shift with 4-5 errors Checklist errors Quantity all patients 6. shift with 0 (zero) error. error error more errors. shift with 0 (zero) error. the shift or with 2-3 errors. the shift or with 4-5 errors. Complete requirements. within <100% of patients. within 100% of patients. errors. within Timeliness completed within shift 100% of patients within 100% of patients within 100% of patients within 100% of patients within <100% of patients within Procedure shift with 6 or more shift with 0 (zero) error. error. within <100% of patients. within Completed midwife 100% of patients within 100% of patients within 100% of patients within 100% of patients within <100% of patients within Timeliness completed within shift shift with 6 or more procedures shift with 0 (zero) error. on or case study/ and/or 1-24 hours after and/or 25-48 hours after and/or 49-72 hours after and/or more than 72 before deadline with 0-1 before deadline with 0-1 research paper deadline and/or with 2-3 deadline and/or with 4-5 deadline and/or with 6-7 hours after deadline error. within 100% of patients. Individual Work Output Table ____Office of the Nursing Service _____ _____________________________________________ ________Registered Midwiife II SG-11________ ___________Clinical Care Branch . with 0-1 Quality Incomplete error Completed Complete requirements. and/or with more than 8 errors . shift with 0 (zero) error. shift with 4-5 errors errors Quantity all patients 5. with 2-3 errors. within Completed midwife 100% of patients within 100% of patients within 100% of patients within 100% of patients within <100% of patients within shift with 6 or more administrative work shift with 0 (zero) error. shift with 6 or more supply/Equipment shift with 0 (zero) error. with 2-3 errors. within <100% of patients. shift with 4-5 errors errors discharge Quantity all patients 10. shift. the shift or with 2-3 errors. within <100% of patients. NAP 5S Deficiency Record Quality No error Accomplished 5s 100% of all assigned 100% of all assigned 100% of all assigned 100% of all assigned <100% of all assigned <100% of all assigned standard at all Timeliness completed within shift areas within shift with 0 areas within shift with 0 areas within shift with 1 areas within shift with 2 areas within shift with 3 areas within shift with 4 assigned areas (zero) error. the shift or with 2-3 errors. Quantity all patients 4. within 100% of patients. error. (zero) error. Clinical Area Equipment/Supply Record Complete Quality No error <100% of accounting of 100% of 100% of supply/Equipment 100% of <100% of Timeliness within shift 100% of supply/Equipment supply/Equipment within clinical area supply/Equipment within within shift with 0 (zero) supply/Equipment within supply/Equipment within within shift with 1 error. within the shift. Quantity all patients 3. shift with 3 errors. Complete requirements. Midwife Procedures Deficiency Record Quality No error <100% of patients. on or Excellent substance. with zero (0) the shift. within 100% of patients. with zero (0) the shift or with 6 or patient data Timeliness within shift the shift. Health Teaching Record Quality No error Completed Health <100% of patients. within 100% of patients.

error. errors. errors. on or case study/ and/or 1-24 hours after and/or 25-48 hours after and/or 49-72 hours after and/or more than 72 before deadline with 0-1 before deadline with 0-1 research paper deadline and/or with 2-3 deadline and/or with 4-5 deadline and/or with 6-7 hours after deadline error. Complete requirements. on or Excellent substance. Complete requirements. and/or with more than 8 errors . requirements for very sufficient substance sufficient substance insufficient substance unacceptable substance Excellent substance. biannually Quantity Complete requirements errors.

100% of patients within shift with 0 (zero) error. with zero (0) Reporting Deficiency 100% of patients. with zero (0) error 5 5 5 5 Well organized error Record 100% of patients. within the shift. within the shift. 5 5 5 5 clearly understood by patients . _______________________ Employee Date: ___________________ Reviewed by Date Approved by Date CPT ANNABELLE G DELA TORRES NC MAJ SERAFFIN L SORIANO NC Immediate Supervisor Head of Office Rating Output Success Indicator (Target + Measure) Actual Accomplishments Remarks Ql1 Qn2 T3 A4 Core Function Vital Signs / I&O 100% of patients. Comprehensive and Health Teaching Record 100% of patients within shift with 0 (zero) error. 5 5 5 5 staff Record NAP 5S Deficiency 100% of all assigned areas within shift with 0 100% of all assigned areas within shift with 0 (zero) 5 5 5 5 Area well maintained Record (zero) error. error. within the shift. MS. 100% of patients within shift with 0 (zero) error. within the shift. within the shift. with zero (0) error 5 5 5 5 Monitoring Sheet error staff NAP Critical Patient 100% of patients. INDIVIDUAL PERFORMANCE COMMITMENT AND REVIEW (IPCR) I. of the Obstetrics and Gynecology Ward. 2015. within the shift. Division of Nursing commit to deliver and agree to be rated on the attainment of the following targets in accordance with the indicated measures for the period July to December. with zero (0) Well appreciated by co- 100% of patients. MARICEL F MORALES RM II. 5 5 5 5 Deficiency Record performed EINC Procedure Well appreciated by co- Checklist Deficiency 100% of patients within shift with 0 (zero) error. with zero (0) error 5 5 5 5 Comprehensive error Midwife Procedures Systematically 100% of patients within shift with 0 (zero) error. 100% of patients within shift with 0 (zero) error. with zero (0) Labor Monitoring Sheet 100% of patients.

Average (A) . 5 5 5 5 Well maintained (zero) error.25 Overall Equivalent Adjectival Rating Outstanding Comments and Recommendations for Development Purposes Discussed with Date Assessed by Date Final Rating by Date I certify that I discussed my assessment of the performance with the employee MS. Excellent substance.00 5. on Complete requirements. Complete requirements. MARICEL F MORALES RM II CPT ANNABELLE G DELA TORRES NC MAJ SERAFFIN L SORIANO NC Employee Supervisor Head of Office Legend: 1 . 100% of patients within shift with 0 (zero) error. Excellent substance.00 Intervening point score . Record Records.Quantity (Qn) 3 . before deadline with 0-1 error.75 Overall Equivalent Numerical Rating 4.00 Overall point score 5.0. 5 5 5 5 Deficiency Record well maintained and organized Research / HRDP . research Average point score 5. and Midwife Administrative Birth Certificate Filing 100% of patients within shift with 0 (zero) error. Cases.Timeliness (T) 4 .00 5. on or Relevant conducted 5 5 5 5 COPAR or before deadline with 0-1 error.00 5.Support Function Clinical Area 100% of equipment/ supply within shift with 0 Equipment / Supply 100% of patients within shift with 0 (zero) error.Quality (Ql) 2 .

with zero (0) the shift. Midwife Procedures Deficiency Record Quality No error <100% of patients. shift with 4-5 errors errors Quantity all patients 9. error. shift with 1 error. errors. with zero (0) the shift. within Timeliness completed within shift 100% of patients within 100% of patients within 100% of patients within 100% of patients within <100% of patients within Procedure shift with 6 or more shift with 0 (zero) error. with zero (0) the shift or with 6 or the shift. shift with 3 errors. shift with 1 error. shift with 1 error. shift. within Completed midwife 100% of patients within 100% of patients within 100% of patients within 100% of patients within <100% of patients within shift with 6 or more administrative work shift with 0 (zero) error. within 100% of patients. and/or with more than 8 errors . errors. or with 1 error. the shift or with 4-5 errors. requirements for Timeliness On or before deadline very sufficient substance sufficient substance insufficient substance unacceptable substance Excellent substance. 2. Quantity all patients 3. the shift or with 4-5 errors. shift with 4-5 errors errors Quantity all patients 5. shift. error error more errors. within 100% of patients. NAP 5S Deficiency Record Quality No error Accomplished 5s 100% of all assigned 100% of all assigned 100% of all assigned 100% of all assigned <100% of all assigned <100% of all assigned standard at all Timeliness completed within shift areas within shift with 0 areas within shift with 0 areas within shift with 1 areas within shift with 2 areas within shift with 3 areas within shift with 4 assigned areas (zero) error. with 2-3 errors. shift with 1 error. error. NAP Critical Patient Reporting Deficiency Record Quality accurate 100% of patients. patient data Quantity all patients error error more errors. within pediatric Timeliness within shift the shift. Complete requirements. on or case study/ and/or 1-24 hours after and/or 25-48 hours after and/or 49-72 hours after and/or more than 72 before deadline with 0-1 before deadline with 0-1 research paper deadline and/or with 2-3 deadline and/or with 4-5 deadline and/or with 6-7 hours after deadline error. shift with 0 (zero) error. (zero) error. within <100% of patients. Complete requirements. shift. with zero (0) the shift or with 6 or patient data the shift. with 2-3 errors. within 100% of patients. error. shift with 6 or more supply/Equipment shift with 0 (zero) error. Incomplete requirements. with 2-3 errors.COPAR excellent substance. within <100% of patients. within shift 8. within 100% of patients. Vital signs/ I&O Monitoring Sheet Quality accurate monitors and Timeliness within shift 100% of patients. within 100% of patients. within Completed midwife 100% of patients within 100% of patients within 100% of patients within 100% of patients within <100% of patients within Timeliness completed within shift shift with 6 or more procedures shift with 0 (zero) error. with 0-1 Quality Incomplete error Completed Complete requirements. Midwife Administrative Deficiency Record Quality No error Timeliness completed within shift <100% of patients. error. within <100% of patients. error. shift with 4-5 errors errors discharge Quantity all patients 10. the shift or with 2-3 errors. Individual Work Output Table ____Office of the Nursing Service _____ _____________________________________________ ________Registered Midwiife II SG-11________ ___________Clinical Care Branch . within 100% of patients. EINC Procedure Checklist Deficiency Record Quality No error Completed EINC <100% of patients. shift with 0 (zero) error. with 2-3 errors.Neonatal Intensive Care Unit (NICU)_____ PERFORMANCE SUCCESS INDICATOR PERFORMANCE STANDARDS Major Final Outputs PERFORMANCE TARGETS MEASURES Measures + Targets Outstanding Very Satisfactory Satisfactory Unsatisfactory Poor 1. Research / HRDP . within 100% of patients. Neonatal Assessment Deficiency Record Quality accurate report accurate 100% of patients. within <100% of patients. within report accurate 100% of patients. shift with 0 (zero) error. the shift or with 2-3 errors. within records accurate the shift. Complete requirements. error. with zero (0) the shift. within <100% of patients. the shift or with 2-3 errors. with zero (0) the shift or with 6 or the shift. within Teaching Protocol Timeliness completed within shift 100% of patients within 100% of patients within 100% of patients within 100% of patients within <100% of patients within shift with 6 or more of all patients upon shift with 0 (zero) error. within <100% of patients. Quantity all equipment and supply errors. or with 1 error. shift. requirements. shift with 4-5 errors Checklist errors Quantity all patients 6. assessment error error more errors. within 100% of patients. within Timeliness within shift the shift. biannually errors. on or Excellent substance. shift with 2 errors. within the shift Quantity all assigned areas 7. shift with 0 (zero) error. Clinical Area Equipment/Supply Record Complete Quality No error <100% of accounting of 100% of 100% of supply/Equipment 100% of <100% of Timeliness within shift 100% of supply/Equipment supply/Equipment within clinical area supply/Equipment within within shift with 0 (zero) supply/Equipment within supply/Equipment within within shift with 1 error. Health Teaching Record Quality No error Completed Health <100% of patients. or with 1 error. Quantity all patients 4. the shift or with 4-5 errors.

error. requirements for very sufficient substance sufficient substance insufficient substance unacceptable substance Excellent substance. errors. Complete requirements. Complete requirements. errors. on or Excellent substance. biannually Quantity Complete requirements errors. and/or with more than 8 errors . on or case study/ and/or 1-24 hours after and/or 25-48 hours after and/or 49-72 hours after and/or more than 72 before deadline with 0-1 before deadline with 0-1 research paper deadline and/or with 2-3 deadline and/or with 4-5 deadline and/or with 6-7 hours after deadline error.

within the shift. within the shift. DORINA T SANCHEZ RM II. 100% of patients within shift with 0 (zero) error. within the shift. with zero (0) Reporting Deficiency 100% of patients. 1 1 1 1 accomplish most of the Record EINC Checklist form . with zero (0) <100% of patients. 4 4 4 4 error Record Neonatal Assessment 100% of patients. within the shift. 2015. or with 1 error. within the shift or with 4 errors. Division of Nursing commit to deliver and agree to be rated on the attainment of the following targets in accordance with the indicated measures for the period July to December. of the Neonatal Intensive Care Unit. 5 5 5 5 maternal and child care Deficiency Record competently EINC Procedure Was not able to Checklist Deficiency 100% of patients within shift with 0 (zero) error. within the shift. 100% of patients within shift with 8 errors. with zero (0) 100% of patients. with 3 errors 3 3 3 3 Monitoring Sheet error NAP Critical Patient 100% of patients. 2 2 2 2 Deficiency Record error Performs integrated Midwife Procedures 100% of patients within shift with 0 (zero) error. INDIVIDUAL PERFORMANCE COMMITMENT AND REVIEW (IPCR) I. MS. _______________________ Employee Date: ___________________ Reviewed by Date Approved by Date CPT CERULLO P MANLAPAT NC MAJ THOMAS O DE CASTRO NC Immediate Supervisor Head of Office Rating Output Success Indicator (Target + Measure) Actual Accomplishments Remarks Ql1 Qn2 T3 A4 Core Function Vital signs/ I&O 100% of patients.

Cord Health Teaching Record 100% of patients within shift with 0 (zero) error. 100% of patients within shift with 0 (zero) error. 5 5 5 5 Care. Newborn Bathing and Immunization follow ups were conducted comprehensively . Health Education rendered to patients on Breast Feeding.

3 3 3 3 Record (zero) error. Excellent substance.Average (A) .20 3.Support Function NAP 5S Deficiency 100% of all assigned areas within shift with 0 100% of all assigned areas within shift with 2 errors. Record recording. incomplete (zero) error. before deadline with 0-1 error.20 Intervening point score -0. Failed to report Clinical Area unserviceable ward 100% of supply/Equipment within shift with 0 Equipment/Supply <100% of supply/Equipment within shift with 10 errors.Quality (Ql) 2 .20 3. on or 5 5 5 5 COPAR or before deadline with 0-1 error.Timeliness (T) 4 .25 Overall Equivalent Numerical Rating 2.20 Overall point score 3. stock cards were not updated Midwife Administrative 100% of patients within shift with 0 (zero) error.Quantity (Qn) 3 .20 3. on Complete requirements. 100% of patients within shift with 2 errors. 3 3 3 3 Deficiency Record Research / HRDP . 1 1 1 1 equipments.95 Overall Equivalent Adjectival Rating Satisfactory Comments and Recommendations for Development Purposes Discussed with Date Assessed by Date Final Rating by Date I certify that I discussed my assessment of the performance with the employee MS. Complete requirements. Average point score 3. DORINA T SANCHEZ RM II RM II CPT CERULLO P MANLAPAT NC MAJ THOMAS O DE CASTRO NC Employee Supervisor Head of Office Legend: 1 . Excellent substance.

within 100% of patients. shift with 0 (zero) error. within 100% of patients. within Completed midwife 100% of patients within 100% of patients within 100% of patients within 100% of patients within <100% of patients within shift with 6 or more administrative work shift with 0 (zero) error. within <100% of patients. with zero (0) the shift or with 6 or the shift. within <100% of patients. shift with 1 error. Clinical Area Equipment/Supply Record Complete Quality No error <100% of accounting of 100% of 100% of supply/Equipment 100% of <100% of Timeliness within shift 100% of supply/Equipment supply/Equipment within clinical area supply/Equipment within within shift with 0 (zero) supply/Equipment within supply/Equipment within within shift with 1 error. within pediatric Timeliness within shift the shift. errors. the shift or with 4-5 errors. and/or with more than 8 errors . within 100% of patients. sufficient irrelevant. within shift 8. within <100% of patients. shift with 4-5 errors errors Quantity all patients 5. within the shift Quantity all assigned areas 7. Complete requirements. shift with 4-5 errors errors Quantity all patients 9. with 2-3 errors. shift with 4-5 errors errors discharge Quantity all patients 10. within Timeliness within shift the shift. requirements. error. 2. or with 1 error. within 100% of patients. the shift or with 2-3 errors. within <100% of patients. Incomplete requirements. within Completed midwife 100% of patients within 100% of patients within 100% of patients within 100% of patients within <100% of patients within Timeliness completed within shift shift with 6 or more procedures shift with 0 (zero) error. within report accurate 100% of patients. with 0-1 Quality Incomplete error Completed Complete requirements. sufficient relevant. error error more errors. or with 1 error. errors. NAP 5S Deficiency Record Quality No error Accomplished 5s 100% of all assigned 100% of all assigned 100% of all assigned 100% of all assigned <100% of all assigned <100% of all assigned standard at all Timeliness completed within shift areas within shift with 0 areas within shift with 0 areas within shift with 1 areas within shift with 2 areas within shift with 3 areas within shift with 4 assigned areas (zero) error.COPAR excellent substance. shift with 1 error. with 2-3 errors. (zero) error. shift with 6 or more supply/Equipment shift with 0 (zero) error. within 100% of patients. the shift or with 4-5 errors. insufficient Relevant conduct Timeliness On or before deadline relevant Integrated relevant Integrated relevant. shift with 1 error. shift. insufficient substancePediatric of all Integrated Pediatric Growth and Pediatric Growth and substance Pediatric substance Pediatric substance Pediatric Growth and Pediatric Growth Development Programs Development Programs Growth and Development Growth and Development Growth and Development Development Programs and Development reported on or before reported on or before Programs reported and/or Programs reported and/or Programs reported and/or reported and/or more Programs Quantity all program reports deadline deadline 1-24 hours after deadline 25-48 hours after deadline 49-72 hours after deadline than 72 hours after deadline 6. error. shift with 0 (zero) error. assessment error error more errors. Vital signs/ I&O Monitoring Sheet Quality accurate monitors and Timeliness within shift 100% of patients. Quantity all patients 4. error. NAP Critical Patient Reporting Deficiency Record Quality accurate 100% of patients. shift. within records accurate the shift. within 100% of patients. Quantity all patients 3. patient data Quantity all patients error error more errors. shift. the shift or with 2-3 errors.Pediatric Ward (W6C)_____ PERFORMANCE SUCCESS INDICATOR PERFORMANCE STANDARDS Major Final Outputs PERFORMANCE TARGETS MEASURES Measures + Targets Outstanding Very Satisfactory Satisfactory Unsatisfactory Poor 1. with zero (0) the shift. Research / HRDP . Pediatric Assessment Deficiency Record Quality accurate report accurate 100% of patients. the shift or with 2-3 errors. within <100% of patients. the shift or with 4-5 errors. within 100% of patients. error. Quantity all equipment and supply errors. with zero (0) the shift or with 6 or the shift. Complete requirements. Midwife Administrative Deficiency Record Quality No error Timeliness completed within shift <100% of patients. shift with 2 errors. Complete requirements. Pediatric Growth and Development Program Reports Quality Relevant <100% of conducted 100% of conducted 100% of conducted 100% of conducted 100% of conducted <100% of conducted irrelevant. within 100% of patients. shift with 0 (zero) error. on or case study/ and/or 1-24 hours after and/or 25-48 hours after and/or 49-72 hours after and/or more than 72 before deadline with 0-1 before deadline with 0-1 research paper deadline and/or with 2-3 deadline and/or with 4-5 deadline and/or with 6-7 hours after deadline error. with zero (0) the shift. within <100% of patients. or with 1 error. Health Teaching Record Quality No error Completed Health <100% of patients. biannually errors. on or Excellent substance. with zero (0) the shift or with 6 or patient data the shift. error. Individual Work Output Table ____Office of the Nursing Service _____ _____________________________________________ ________Registered Midwiife II SG-11________ ___________Clinical Care Branch . error. with zero (0) the shift. Midwife Procedures Deficiency Record Quality No error <100% of patients. shift with 3 errors. within Teaching Protocol Timeliness completed within shift 100% of patients within 100% of patients within 100% of patients within 100% of patients within <100% of patients within shift with 6 or more of all patients upon shift with 0 (zero) error. requirements for Timeliness On or before deadline very sufficient substance sufficient substance insufficient substance unacceptable substance Excellent substance. with 2-3 errors.

Complete requirements. errors. errors. on or case study/ and/or 1-24 hours after and/or 25-48 hours after and/or 49-72 hours after and/or more than 72 before deadline with 0-1 before deadline with 0-1 research paper deadline and/or with 2-3 deadline and/or with 4-5 deadline and/or with 6-7 hours after deadline error. biannually Quantity Complete requirements errors. and/or with more than 8 errors . on or Excellent substance. Complete requirements. error. requirements for very sufficient substance sufficient substance insufficient substance unacceptable substance Excellent substance.

_______________________ Employee Date: ___________________ Reviewed by Date Approved by Date CPT VICTORIA B DE ROCAS NC LTC DENNIS R FERRER NC Immediate Supervisor Head of Office Rating Output Success Indicator (Target + Measure) Actual Accomplishments Remarks Ql1 Qn2 T3 A4 Core Function Vital Signs / I&O 100% of patients. 100% of patients within shift with 1 error. with zero (0) 100% of patients. within the shift. within the shift or with 4-5 errors. within the shift or with 2-3 errors. 2015. 4 4 4 4 . 3 3 3 3 Deficiency Record error Midwife Procedures 100% of patients within shift with 0 (zero) error. 2 2 2 2 error Record Pediatric Assessment 100% of patients. CRESENCIA F MENDOZA RM II. 3 3 3 3 Deficiency Record Proactive involvement on Child Life Program Pediatric Growth and 100% of conducted relevant Integrated Pediatric 100% of conducted relevant Integrated Pediatric and Kythe Foundation Development Program Growth and Development Programs reported on Growth and Development Programs reported on or 5 5 5 5 activities as well as on Reports or before deadline before deadline the conduct of School Readiness Program Health Teaching Record 100% of patients within shift with 0 (zero) error. within the shift. within the shift or with 2-3 errors. of the Pediatric Ward. with zero (0) 100% of patients. within the shift. MS. 100% of patients within shift with 2 errors. 3 3 3 3 Monitoring Sheet error NAP Critical Patient 100% of patients. Division of Nursing commit to deliver and agree to be rated on the attainment of the following targets in accordance with the indicated measures for the period July to December. with zero (0) Reporting Deficiency <100% of patients. INDIVIDUAL PERFORMANCE COMMITMENT AND REVIEW (IPCR) I.

80 Overall point score 2. 1 1 1 1 Record (zero) error. CRESENCIA F MENDOZA RM II CPT VICTORIA B DE ROCAS NC LTC DENNIS R FERRER NC Employee Supervisor Head of Office Legend: 1 .80 Intervening point score 0. Excellent substance.Support Function Housekeeping complied NAP 5S Deficiency 100% of all assigned areas within shift with 0 but needs to clear <100% of all assigned areas within shift with 8 errors.80 2.80 2.80 2. before deadline with 0-1 error. on or 5 5 5 5 Very relevant COPAR or before deadline with 0-1 error.80 Overall Equivalent Adjectival Rating Satisfactory Comments and Recommendations for Development Purposes Discussed with Date Assessed by Date Final Rating by Date I certify that I discussed my assessment of the performance with the employee MS.00 Overall Equivalent Numerical Rating 2. <100% of patients. after the shift with 6 errors 1 1 1 1 of childhood illnesses Deficiency Record and pediatric ward prevalent cases Research / HRDP .Timeliness (T) 4 . Record labeled and placed on proper container Needs improvement on reporting and recording Midwife Administrative 100% of patients within shift with 0 (zero) error. Complete requirements. 1 1 1 1 supplies not properly (zero) error. Excellent substance. on Complete requirements.Average (A) .Quantity (Qn) 3 .Quality (Ql) 2 . clinical area before endorsement Clinical Area Clinical Area disorganized and 100% of supply/Equipment within shift with 0 Equipment / Supply <100% of supply/Equipment within shift with 6 errors. Average point score 2.

within 100% of patients. with zero (0) the shift. within 100% of patients. within Completed midwife 100% of patients within 100% of patients within 100% of patients within 100% of patients within <100% of patients within Timeliness completed within shift shift with 6 or more procedures shift with 0 (zero) error. labor error error more errors. within <100% of patients. shift with 0 (zero) error. within 100% of patients. shift with 1 error. Vital signs/ I&O Monitoring Sheet Quality accurate Timeliness within shift 100% of patients. NAP Deficiency in Reporting Critical Patient Data Record Quality accurate 100% of patients. within monitors and records 100% of patients. shift. within <100% of patients. error error more errors. or with 1 error. the shift or with 2-3 errors. NAP 5S Deficiency Record Quality No error Accomplished 5s Timeliness completed within shift 100% of all assigned 100% of all assigned 100% of all assigned 100% of all assigned <100% of all assigned <100% of all assigned standard at all areas within shift with 0 areas within shift with 0 areas within shift with 1 areas within shift with 2 areas within shift with 3 areas within shift with 4 assigned areas within (zero) error. Quantity all patients error error more errors. Quantity all patients 5. with zero (0) the shift or with 6 or patient data Timeliness within shift the shift. shift. Clinical Area Equipment/Supply Record Quality No error Complete accounting <100% of 100% of 100% of supply/Equipment 100% of <100% of of nursing Timeliness within shift 100% of supply/Equipment supply/Equipment within supply/Equipment within within shift with 0 (zero) supply/Equipment within supply/Equipment within supply/Equipment within shift with 1 error. within 100% of patients. shift with 6 or more shift with 0 (zero) error. within <100% of patients. within the shift. shift with 3 errors. shift with 4-5 errors errors discharge Quantity all patients . or with 1 error. Midwife Procedures Deficiency Record Quality No error <100% of patients. EINC Procedure Checklist Deficiency Record Quality No error <100% of patients. the shift or with 4-5 errors. Labor Monitoring Sheet Quality accurate report accurate 100% of patients. or with 1 error. error. within progress of patient Timeliness within shift the shift. Health Teaching Record Quality No error Completed Health <100% of patients. with zero (0) the shift or with 6 or the shift. with zero (0) the shift or with 6 or accurate patient data the shift. within <100% of patients. shift with 0 (zero) error. within Teaching Protocol of Timeliness completed within shift 100% of patients within 100% of patients within 100% of patients within 100% of patients within <100% of patients within shift with 6 or more all patients upon shift with 0 (zero) error.9________ ___________Clinical Care Branch . the shift Quantity all assigned areas 7. within 100% of patients. Quantity all patients 3. the shift or with 4-5 errors. error. error. the shift or with 4-5 errors. 2. within 100% of patients. Quantity all equipment and supply 8. with 2-3 errors.Obstetrics and Gynecology Ward (OBGYN)_______ PERFORMANCE SUCCESS INDICATOR PERFORMANCE STANDARDS Major Final Outputs PERFORMANCE TARGETS MEASURES Measures + Targets Outstanding Very Satisfactory Satisfactory Unsatisfactory Poor 1. with 2-3 errors. with 2-3 errors. (zero) error. the shift or with 2-3 errors. within the shift. shift. within Completed EINC Timeliness completed within shift 100% of patients within 100% of patients within 100% of patients within 100% of patients within <100% of patients within shift with 6 or more Procedure Checklist shift with 0 (zero) error. shift with 1 error. shift with 2 errors. within 100% of patients. shift with 1 error. Individual Work Output Table ____Office of the Nursing Service _____ _____________________________________________ ________Registered Midwiife I SG. within <100% of patients. error. within shift errors. within report accurate 100% of patients. the shift or with 2-3 errors. with zero (0) the shift. with zero (0) the shift. shift with 4-5 errors errors Quantity all patients 4. shift with 4-5 errors errors Quantity all patients 6. within <100% of patients. shift with 0 (zero) error. error.

within the shift. within the shift. 4 4 4 4 . of the Obstetrics and Gynecology Ward. with zero (0) Labor Monitoring Sheet 100% of patients. with zero (0) 100% of patients. or with 1 error. with 3 errors. within the shift. 3 3 3 3 Deficiency Record 100% of patients. 3 3 3 3 error EINC Procedure Checklist Deficiency 100% of patients within shift with 0 (zero) error. LORENA P CRUZ RM I. INDIVIDUAL PERFORMANCE COMMITMENT AND REVIEW (IPCR) I. 3 3 3 3 Monitoring Sheet error NAP Deficiency in 100% of patients. 100% of patients. 100% of patients. MS. 3 3 3 3 error Patient Data Record Midwife Procedures 100% of patients within shift with 0 (zero) error. 4 4 4 4 Record Health Teaching Record 100% of patients within shift with 0 (zero) error. Division of Nursing commit to deliver and agree to be rated on the attainment of the following targets in accordance with the indicated measures for the period July to December. 100% of patients within shift. within the shift or with 3 errors. or with 1 error. within the shift or with 2 errors. with zero (0) Reporting Critical 100% of patients. within the shift or with 2 errors. within the shift. _______________________ Employee Date: ___________________ Reviewed by Date Approved by Date CPT GRACE MARIE N SANTOS NC LTC JAMES PAUL C DEL ROSARIO NC Immediate Supervisor Head of Office Rating Output Success Indicator (Target + Measure) Actual Accomplishments Remarks Ql1 Qn2 T3 A4 Core Function Vital signs/ I&O 100% of patients. within the shift. 2015.

25 3. 3 3 3 3 (zero) error.50 Overall Equivalent Numerical Rating 3.25 Intervening point score 0.25 3. Clinical Area 100% of supply/Equipment within shift with 0 Equipment/Supply 100% of supply/Equipment within shift with 2 errors. LORENA P CRUZ RM I CPT GRACE MARIE N SANTOS NC ROSARIO NC Employee Supervisor Head of Office Legend: 1 .75 Overall Equivalent Adjectival Rating Very Satisfactory Comments and Recommendations for Development Purposes Discussed with Date Assessed by Date Final Rating by Date I certify that I discussed my assessment of the performance with the employee LTC JAMES PAUL C DEL MS.Average (A) .25 Overall point score 3.25 3.Timeliness (T) 4 . 3 3 3 3 Record (zero) error.Quality (Ql) 2 . Record Average point score 3.Quantity (Qn) 3 .Support Function NAP 5S Deficiency 100% of all assigned areas within shift with 0 100% of all assigned areas within shift with 2 error.

Health Teaching Record Quality No error Completed Health <100% of patients. within Teaching Protocol Timeliness completed within shift 100% of patients within 100% of patients within 100% of patients within 100% of patients within <100% of patients within shift with 6 or more of all patients upon shift with 0 (zero) error. within 100% of patients. within Completed midwife 100% of patients within 100% of patients within 100% of patients within 100% of patients within <100% of patients within Timeliness completed within shift shift with 6 or more procedures shift with 0 (zero) error. with zero (0) the shift or with 6 or the shift. Quantity all equipment and supply errors. Individual Work Output Table ____Office of the Nursing Service _____ _____________________________________________ ________Registered Midwiife I SG-9________ ___________Clinical Care Branch . shift with 4-5 errors errors discharge Quantity all patients . within the shift Quantity all assigned areas 7. within <100% of patients. shift with 2 errors. Quantity all patients 4.Neonatal Intensive Care Unit (NICU)____ PERFORMANCE SUCCESS INDICATOR PERFORMANCE STANDARDS Major Final Outputs PERFORMANCE TARGETS MEASURES Measures + Targets Outstanding Very Satisfactory Satisfactory Unsatisfactory Poor 1. within 100% of patients. within shift 8. Midwife Procedures Deficiency Record Quality No error <100% of patients. within <100% of patients. NAP Critical Patient Reporting Deficiency Record Quality accurate 100% of patients. shift with 0 (zero) error. Vital signs/ I&O Monitoring Sheet Quality accurate monitors and Timeliness within shift 100% of patients. shift with 1 error. with zero (0) the shift or with 6 or patient data the shift. within <100% of patients. within Timeliness completed within shift 100% of patients within 100% of patients within 100% of patients within 100% of patients within <100% of patients within Procedure shift with 6 or more shift with 0 (zero) error. within 100% of patients. within 100% of patients. shift with 4-5 errors Checklist errors Quantity all patients 6. shift with 0 (zero) error. or with 1 error. error. error. within <100% of patients. shift with 3 errors. (zero) error. error. within <100% of patients. shift. 2. EINC Procedure Checklist Deficiency Record Quality No error Completed EINC <100% of patients. NAP 5S Deficiency Record Quality No error Accomplished 5s 100% of all assigned 100% of all assigned 100% of all assigned 100% of all assigned <100% of all assigned <100% of all assigned standard at all Timeliness completed within shift areas within shift with 0 areas within shift with 0 areas within shift with 1 areas within shift with 2 areas within shift with 3 areas within shift with 4 assigned areas (zero) error. within <100% of patients. the shift or with 4-5 errors. the shift or with 4-5 errors. Clinical Area Equipment/Supply Record Complete Quality No error <100% of accounting of 100% of 100% of supply/Equipment 100% of <100% of Timeliness within shift 100% of supply/Equipment supply/Equipment within clinical area supply/Equipment within within shift with 0 (zero) supply/Equipment within supply/Equipment within within shift with 1 error. within 100% of patients. assessment error error more errors. with zero (0) the shift. shift with 1 error. within 100% of patients. or with 1 error. or with 1 error. shift with 1 error. with zero (0) the shift. within report accurate 100% of patients. within Timeliness within shift the shift. with 2-3 errors. within records accurate the shift. Neonatal Assessment Deficiency Record Quality accurate report accurate 100% of patients. the shift or with 2-3 errors. error. within pediatric Timeliness within shift the shift. error. shift with 0 (zero) error. with zero (0) the shift or with 6 or the shift. shift with 4-5 errors errors Quantity all patients 5. within 100% of patients. the shift or with 4-5 errors. the shift or with 2-3 errors. shift. with zero (0) the shift. Quantity all patients 3. shift. with 2-3 errors. shift with 6 or more supply/Equipment shift with 0 (zero) error. patient data Quantity all patients error error more errors. within 100% of patients. error error more errors. the shift or with 2-3 errors. with 2-3 errors.

with zero (0) 100% of patients. within the shift or with 2 errors. 3 3 3 3 Deficiency Record EINC Procedure Checklist Deficiency 100% of patients within shift with 0 (zero) error. _______________________ Employee Date: ___________________ Reviewed by Date Approved by Date CPT CHRISTIAN RAEGAN L IGNACIO NC LTC MARIA AURORA O TORRES NC Immediate Supervisor Head of Office Rating Output Success Indicator (Target + Measure) Actual Accomplishments Remarks Ql1 Qn2 T3 A4 Core Function Vital signs/ I&O 100% of patients. CRISTINA C VALENCIANO RM I. with zero (0) Reporting Deficiency 100% of patients. with 3 errors. of the Neonatal Intensive Care Unit. with 3 errors. 100% of patients within shift. INDIVIDUAL PERFORMANCE COMMITMENT AND REVIEW (IPCR) I. 3 3 3 3 Monitoring Sheet error NAP Critical Patient 100% of patients. 3 3 3 3 . with zero (0) 100% of patients. 3 3 3 3 Record Health Teaching Record 100% of patients within shift with 0 (zero) error. 2015. with 2 errors. 100% of patients within shift. within the shift. within the shift or with 3 errors. Division of Nursing commit to deliver and agree to be rated on the attainment of the following targets in accordance with the indicated measures for the period July to December. within the shift. within the shift. 3 3 3 3 Deficiency Record error Midwife Procedures 100% of patients within shift with 0 (zero) error. 3 3 3 3 error Record Neonatal Assessment 100% of patients. within the shift or with 2 errors. 100% of patients within shift. MS.

00 Intervening point score 0.Timeliness (T) 4 . 3 3 3 3 (zero) error.00 Overall point score 3.Quantity (Qn) 3 .00 3.75 Overall Equivalent Adjectival Rating Very Satisfactory Comments and Recommendations for Development Purposes Discussed with Date Assessed by Date Final Rating by Date I certify that I discussed my assessment of the performance with the employee MS.00 3. CRISTINA C VALENCIANO RM I CPT CHRISTIAN RAEGAN L IGNACIO NC LTC MARIA AURORA O TORRES NC Employee Supervisor Head of Office Legend: 1 .Average (A) .Quality (Ql) 2 . Clinical Area 100% of supply/Equipment within shift with 0 Equipment/Supply 100% of supply/Equipment within shift with 2 errors.00 3. Record Average point score 3.Support Function NAP 5S Deficiency 100% of all assigned areas within shift with 0 100% of all assigned areas within shift with 2 error.75 Overall Equivalent Numerical Rating 3. 3 3 3 3 Record (zero) error.

the shift or with 2-3 errors. within <100% of patients. or with 1 error. error. shift. with zero (0) the shift or with 6 or the shift. shift with 0 (zero) error. with 2-3 errors. shift with 0 (zero) error. the shift or with 2-3 errors. error. shift. shift with 6 or more supply/Equipment shift with 0 (zero) error. with zero (0) the shift. within records accurate the shift. within report accurate 100% of patients. the shift or with 4-5 errors. within shift 7. Individual Work Output Table ____Office of the Nursing Service _____ _____________________________________________ ________Registered Midwiife I SG-9_______ ___________Clinical Care Branch . within <100% of patients. with 2-3 errors. shift with 1 error. within Timeliness within shift the shift. error. within the shift Quantity all assigned areas 6. within 100% of patients. or with 1 error. with zero (0) the shift or with 6 or the shift. 2. within Teaching Protocol Timeliness completed within shift 100% of patients within 100% of patients within 100% of patients within 100% of patients within <100% of patients within shift with 6 or more of all patients upon shift with 0 (zero) error. within 100% of patients. shift with 4-5 errors errors Quantity all patients 8. shift with 3 errors. the shift or with 2-3 errors. shift with 1 error. with zero (0) the shift or with 6 or patient data the shift. Midwife Administrative Deficiency Record Quality No error Timeliness completed within shift <100% of patients. the shift or with 4-5 errors. assessment error error more errors. within <100% of patients.Pediatric Ward (W6C)_____ PERFORMANCE SUCCESS INDICATOR PERFORMANCE STANDARDS Major Final Outputs PERFORMANCE TARGETS MEASURES Measures + Targets Outstanding Very Satisfactory Satisfactory Unsatisfactory Poor 1. Clinical Area Equipment/Supply Record Complete Quality No error <100% of accounting of 100% of 100% of supply/Equipment 100% of <100% of Timeliness within shift 100% of supply/Equipment supply/Equipment within clinical area supply/Equipment within within shift with 0 (zero) supply/Equipment within supply/Equipment within within shift with 1 error. patient data Quantity all patients error error more errors. within Completed midwife 100% of patients within 100% of patients within 100% of patients within 100% of patients within <100% of patients within Timeliness completed within shift shift with 6 or more procedures shift with 0 (zero) error. Quantity all equipment and supply errors. within 100% of patients. shift with 2 errors. shift with 0 (zero) error. within 100% of patients. NAP Critical Patient Reporting Deficiency Record Quality accurate 100% of patients. within Completed midwife 100% of patients within 100% of patients within 100% of patients within 100% of patients within <100% of patients within shift with 6 or more administrative work shift with 0 (zero) error. within 100% of patients. within 100% of patients. Quantity all patients 3. within 100% of patients. within 100% of patients. error. or with 1 error. error. within <100% of patients. within <100% of patients. Midwife Procedures Deficiency Record Quality No error <100% of patients. within <100% of patients. with zero (0) the shift. Health Teaching Record Quality No error Completed Health <100% of patients. shift with 1 error. within pediatric Timeliness within shift the shift. Pediatric Assessment Deficiency Record Quality accurate report accurate 100% of patients. (zero) error. shift with 4-5 errors errors Quantity all patients 5. error error more errors. shift with 4-5 errors errors discharge Quantity all patients . the shift or with 4-5 errors. Vital signs/ I&O Monitoring Sheet Quality accurate monitors and Timeliness within shift 100% of patients. with 2-3 errors. shift. with zero (0) the shift. Quantity all patients 4. NAP 5S Deficiency Record Quality No error Accomplished 5s 100% of all assigned 100% of all assigned 100% of all assigned 100% of all assigned <100% of all assigned <100% of all assigned standard at all Timeliness completed within shift areas within shift with 0 areas within shift with 0 areas within shift with 1 areas within shift with 2 areas within shift with 3 areas within shift with 4 assigned areas (zero) error.

within shift with 10 errors 1 1 1 1 . MS. _______________________ Employee Date: ___________________ Reviewed by Date Approved by Date CPT CARLITO D RENANTE NC MAJ TROY KELLY F DUMAMPILIS NC Immediate Supervisor Head of Office Rating Output Success Indicator (Target + Measure) Actual Accomplishments Remarks Ql1 Qn2 T3 A4 Core Function Vital signs/ I&O 100% of patients. within the shift. Division of Nursing commit to deliver and agree to be rated on the attainment of the following targets in accordance with the indicated measures for the period July to December. within the shift. with zero (0) 100% of patients. with zero (0) Reporting Deficiency 100% of patients. within the shift. or with 1 error. with zero (0) 100% of patients. 4 4 4 4 Deficiency Record error Midwife Procedures 100% of patients within shift with 0 (zero) error. or with 1 error. 4 4 4 4 error Record Pediatric Assessment 100% of patients. within the shift. 4 4 4 4 Monitoring Sheet error NAP Critical Patient 100% of patients. <100% of patients. INDIVIDUAL PERFORMANCE COMMITMENT AND REVIEW (IPCR) I. within the shift. or with 1 error. or with 1 error. 2015. MARIA CONSOLACION D RODRIGUEZ RM I. of the Pediatric Ward. 100% of patients. 4 4 4 4 Deficiency Record Health Teaching Record 100% of patients within shift with 0 (zero) error. within the shift. within the shift.

25 Overall Equivalent Numerical Rating 3. 4 4 4 4 (zero) error.88 Overall Equivalent Adjectival Rating Very Staisfactory Comments and Recommendations for Development Purposes Discussed with Date Assessed by Date Final Rating by Date I certify that I discussed my assessment of the performance with the employee MAJ TROY KELLY F DUMAMPILIS MS. Clinical Area 100% of supply/equipment within shift with 0 Equipment/Supply 100% of supply/equipment within shift with 1 error. 4 4 4 4 Record (zero) error.Quality (Ql) 2 . 4 4 4 4 Deficiency Record Average point score 3. 100% of patients within shift with 1 error. MARIA CONSOLACION D RODRIGUEZ RM I CPT CARLITO D RENANTE NC NC Employee Supervisor Head of Office Legend: 1 .63 3.Timeliness (T) 4 .Support Function NAP 5S Deficiency 100% of all assigned areas within shift with 0 100% of all assigned areas within shift with 1 error.63 Overall point score 3.Average (A) .63 3.63 3. Record Midwife Administrative 100% of patients within shift with 0 (zero) error.63 Intervening point score 0.Quantity (Qn) 3 .

(zero) error. within report accurate 100% of patients. the shift or with 4-5 errors. with zero (0) the shift. within 100% of patients within 100% of patients within 100% of patients within 100% of patients within <100% of patients within delegated nursing Timeliness completed within shift shift with 6 or more shift with 0 (zero) error. with 2-3 tasks . within 100% of patients. within the shift Quantity all assigned areas 5. within <100% of patients. Delegated Nursing Procedure Deficiency Record Quality No error Completed <100% of patients. within <100% of patients. errors. 2. shift with 4-5 errors procedure errors Quantity all patients 4. with 2-3 errors. within shift with 6 administrative within shift with 1 error. Vital signs/ I&O Monitoring Sheet monitors and Quality accurate 100% of patients. or with 1 error. shift with 3 errors. shift with 0 (zero) error. shift with 2 errors. shift with 1 error. error. within records accurate Timeliness within shift the shift. Nursing Equipment/Supply Record Complete Quality No error <100% of accounting of 100% of 100% of supply/Equipment 100% of <100% of Timeliness within shift 100% of supply/Equipment supply/Equipment within nursing supply/Equipment within within shift with 0 (zero) supply/Equipment within supply/Equipment within within shift with 1 error. NAP Deficiency in Reporting Critical Patient Data Record Quality accurate 100% of patients. with zero (0) the shift or with 6 or patient data Timeliness within shift the shift. within shift 6. within shift with 4-5 errors error. error. error error more errors. Delegated Nursing Administrative Deficiency Record Quality No error Completed 100% of delegated tasks 100% of delegated tasks 100% of delegated tasks <100% of delegated delegated nursing Timeliness completed within shift 100% of delegated tasks <100% of delegated tasks within shift with 0 (zero) within shift with 0 (zero) within shift. within <100% of patients. the shift or with 2-3 errors. errors. patient data Quantity all patients error error more errors.Dermatology Ward (W6D)________ PERFORMANCE SUCCESS INDICATOR PERFORMANCE STANDARDS Major Final Outputs PERFORMANCE TARGETS Outstanding Very Satisfactory Satisfactory Unsatisfactory Poor MEASURES Measures + Targets 1. within 100% of patients. within the shift. shift with 6 or more supply/equipment shift with 0 (zero) error. NAP 5S Deficiency Record Accomplished 5s Quality No error 100% of all assigned 100% of all assigned 100% of all assigned 100% of all assigned <100% of all assigned <100% of all assigned standard at all Timeliness completed within shift areas within shift with 0 areas within shift with 0 areas within shift with 1 areas within shift with 2 areas within shift with 3 areas within shift with 4 assigned areas (zero) error. the shift or with 2-3 errors. with zero (0) the shift. or more errors work Quantity all delegated tasks . or more errors work Quantity all delegated tasks 7. within 100% of patients. Quantity all patients 3. error. or with 1 error. within shift with 4-5 errors error. within 100% of patients. error. the shift or with 4-5 errors. with zero (0) the shift or with 6 or the shift. error. within 100% of patients. shift. with 2-3 tasks. within <100% of patients. Individual Work Output Table ____Office of the Nursing Service _____ _____________________________________________ ________Nursing Attendant II SG-6________ ___________Clinical Care Branch . error. error. within shift with 6 administrative within shift with 1 error. NAPIC Management Deficiency Record Quality No error Completed 100% of delegated tasks 100% of delegated tasks 100% of delegated tasks <100% of delegated NAPIC delegated Timeliness completed within shift 100% ofdelegated tasks <100% of delegated tasks within shift with 0 (zero) within shift with 0 (zero) within shift. Quantity all equipment and supply errors.

with zero (0) error 5 5 5 5 error staf Patient Data Record Delegated Nursing 100% of delegated tasks within shift with 0 (zero) Well appreciated by co- Procedure Deficiency 100% ofdelegated tasks within shift with 0 (zero) error. _______________________ Employee Date: ___________________ Reviewed by Date Approved by Date CPT RICHARD F DELA PENA NC LTC RICARDO F SANTOS NC Immediate Supervisor Head of Office Rating Output Success Indicator (Target + Measure) Actual Accomplishments Remarks Ql1 Qn2 T3 A4 Core Function Vital signs/ I&O 100% of patients. 2015. with zero (0) Accurately and 100% of patients. INDIVIDUAL PERFORMANCE COMMITMENT AND REVIEW (IPCR) I. error. within the shift. with zero (0) Well appreciated by co- Reporting Critical 100% of patients. of the Dermatology Ward. 5 5 5 5 error. MARITESS V DELA CRUZ NA II. Deficiency Record complete . Division of Nursing commit to deliver and agree to be rated on the attainment of the following targets in accordance with the indicated measures for the period July to December. MS. within the shift. staf Record Delegated Nursing Administrative reporting 100% of delegated tasks within shift with 0 (zero) 100% of delegated tasks within shift with 0 (zero) Administrative 5 5 5 5 well organized and error. within the shift. within the shift. with zero (0) error 5 5 5 5 Monitoring Sheet error competently done NAP Deficiency in 100% of patients.

Average (A) . maintained and neat Nursing Well maintained and 100% of supply/Equipment within shift with 0 100% of supply/Equipment within shift with 0 (zero) Equipment/Supply 5 5 5 5 Stock Cards are (zero) error.Quantity (Qn) 3 . error. error.Quality (Ql) 2 . Average point score 5.00 5.00 5.00 5.00 Overall Equivalent Adjectival Rating Outstanding Comments and Recommendations for Development Purposes Discussed with Date Assessed by Date Final Rating by Date I certify that I discussed my assessment of the performance with the employee MS. error. Record updated NAPIC Management 100% of delegated tasks within shift with 0 (zero) 100% of delegated tasks within shift with 0 (zero) 5 5 5 5 Well organized Deficiency Record error. MARITESS V DELA CRUZ NA II CPT RICHARD F DELA PENA NC LTC RICARDO F SANTOS NC Employee Supervisor Head of Office Legend: 1 .00 Intervening point score Overall Equivalent Numerical Rating 5.Timeliness (T) 4 .Support Function NAP 5S Deficiency 100% of all assigned areas within shift with 0 100% of all assigned areas within shift with 0 (zero) Clinical Area well 5 5 5 5 Record (zero) error.00 Overall point score 5.

error. error. within records accurate Timeliness within shift the shift. shift with 2 errors. Individual Work Output Table ____Office of the Nursing Service _____ _____________________________________________ ________Nursing Attendant I SG-4________ ___________Clinical Care Branch . 2. within <100% of patients. shift with 4-5 errors procedure errors Quantity all patients 4. within 100% of patients. (zero) error. within report accurate 100% of patients. within <100% of patients. with 2-3 errors. shift with 0 (zero) error. with zero (0) the shift or with 6 or the shift. error. within shift 6. Vital signs/ I&O Monitoring Sheet monitors and Quality accurate 100% of patients. Quantity all patients 3. within the shift. within 100% of patients. NAP Deficiency in Reporting Critical Patient Data Record Quality accurate 100% of patients. patient data Quantity all patients error error more errors. Nursing Equipment/Supply Record Complete Quality No error <100% of accounting of 100% of 100% of supply/Equipment 100% of <100% of Timeliness within shift 100% of supply/Equipment supply/Equipment within nursing supply/Equipment within within shift with 0 (zero) supply/Equipment within supply/Equipment within within shift with 1 error. within 100% of patients. with zero (0) the shift or with 6 or patient data Timeliness within shift the shift. with 2-3 errors. or with 1 error. within 100% of patients. within the shift Quantity all assigned areas 5. the shift or with 4-5 errors. within 100% of patients. error. shift with 3 errors. shift. within delegated nursing Timeliness completed within shift 100% of patients within 100% of patients within 100% of patients within 100% of patients within <100% of patients within shift with 6 or more administrative shift with 0 (zero) error. shift with 1 error.Dermatology and Burn Unit Ward (W6D)________ PERFORMANCE SUCCESS INDICATOR PERFORMANCE STANDARDS Major Final Outputs PERFORMANCE TARGETS Outstanding Very Satisfactory Satisfactory Unsatisfactory Poor MEASURES Measures + Targets 1. error. with zero (0) the shift. the shift or with 4-5 errors. or with 1 error. within <100% of patients. shift with 6 or more supply/equipment shift with 0 (zero) error. shift with 4-5 errors errors work Quantity all patients . Delegated Nursing Administrative Deficiency Record Quality No error Completed <100% of patients. the shift or with 2-3 errors. the shift or with 2-3 errors. shift with 0 (zero) error. within 100% of patients within 100% of patients within 100% of patients within 100% of patients within <100% of patients within delegated nursing Timeliness completed within shift shift with 6 or more shift with 0 (zero) error. NAP 5S Deficiency Record Accomplished 5s Quality No error 100% of all assigned 100% of all assigned 100% of all assigned 100% of all assigned <100% of all assigned <100% of all assigned standard at all Timeliness completed within shift areas within shift with 0 areas within shift with 0 areas within shift with 1 areas within shift with 2 areas within shift with 3 areas within shift with 4 assigned areas (zero) error. error error more errors. Delegated Nursing Procedure Deficiency Record Quality No error Completed <100% of patients. with zero (0) the shift. shift. within <100% of patients. shift with 1 error. Quantity all equipment and supply errors.

within the shift. with zero (0) 100% of patients. staff Record Delegated Nursing 100% of delegated tasks within shift with 0 (zero) 100% of delegated tasks within shift with 0 (zero) Well Appreciated by co- Administrative 5 5 5 5 error. staff Deficiency Record . error. 2015. within the shift. within the shift. with zero (0) Reporting Critical 100% of patients. error. within the shift. _______________________ Employee Date: ___________________ Reviewed by Date Approved by Date CPT GERARD T DE MESA NC LTC RICARDO F SANTOS NC Immediate Supervisor Head of Office Rating Output Success Indicator (Target + Measure) Actual Accomplishments Remarks Ql1 Qn2 T3 A4 Core Function Vital signs/ I&O 100% of patients. with zero (0) error 5 5 5 5 Systematic error Patient Data Record Delegated Nursing 100% of delegated tasks within shift with 0 (zero) 100% of delegated tasks within shift with 0 (zero) Well Appreciated by co- Procedure Deficiency 5 5 5 5 error. MS. with zero (0) error 5 5 5 5 Well Organized Monitoring Sheet error NAP Deficiency in 100% of patients. Division of Nursing commit to deliver and agree to be rated on the attainment of the following targets in accordance with the indicated measures for the period July to December. MARICRIS A DELA RUIZ NA I. of the Dermatology and Burn Ward. INDIVIDUAL PERFORMANCE COMMITMENT AND REVIEW (IPCR) I.

00 5.00 Intervening point score -0.00 Overall point score 5.00 5.Average (A) .Quality (Ql) 2 . MARICRIS A DELA RUIZ NA I CPT GERARD T DE MESA NC LTC RICARDO F SANTOS NC Employee Supervisor Head of Office Legend: 1 . Record Average point score 5.Support Function NAP 5S Deficiency 100% of all assigned areas within shift with 0 100% of all assigned areas within shift with 0 (zero) 5 5 5 5 Well Maintained Record (zero) error.00 5. error. error.50 Overall Equivalent Numerical Rating 4.50 Overall Equivalent Adjectival Rating Outstanding Comments and Recommendations for Development Purposes Discussed with Date Assessed by Date Final Rating by Date I certify that I discussed my assessment of the performance with the employee MS. Nursing 100% of supply/Equipment within shift with 0 100% of supply/Equipment within shift with 0 (zero) Equipment/Supply 5 5 5 5 Well Maintained (zero) error.Quantity (Qn) 3 .Timeliness (T) 4 .

Prepared by: Noted by: Employee's Name and Signature Supervisor's Name and Signature . ID No. (FORM F) Daily Individual Work Output Journal ________________(Office)_________________ __________________(Name)__________________ DATE: __________________(Position/SG)__________________ __________________(Division)__________________ Div Time Revision Output Subject Output Quality Quantity Remarks Assigned Accomplished No.

Weekly Consolidated Individual Work Output Table ________________(Office)_________________ PERIOD COVERED: __________________(Name)__________________ _________________(Position/SG)_________________ __________________(Division)__________________ Div Maximum No. Completed Supervisor's Comments: Prepared by: Reviewed / Noted by: Employee's Name and Signature Supervisor's Name and Signature Date: ________________ Date: _________________ . of Output Date Output Time Quality Quantity Remarks Revisions ID No.

Specify) One-on-One Group Monitoring Coaching Please indicate the date in the appropriate box when the monitoring was conducted. Conducted by: Date: Noted by: Date: Immediate Superior Head of Office . (FORM H) Performance Monitoring and Coaching Journal 1st 2nd Quarter 3rd 4th Name of Division _________________________________ Division Chief ___________________________________ Number of Personnel in the Division _______________ Mechanisms Activity Meeting Remarks Memo Others (Pls.

(Form I) Sample Summary List of Individual Performance Rating Office A Performance Assessment: Very Satisfactory Rating Division A Numerical Adjectival Division A Rating Employee 1 Employee 2 Employee 3 Employee 4 Employee 5 No. of Employees = 4 Average ratings of staff Rating Division C Numerical Adjectival Division C Rating Employee 1 Employee 2 Employee 3 Employee 4 No. of Employees = 5 Average ratings of staff Summary: Division A 4 Very Satisfactory Division B 3 Satisfactory Division C 5 Outstanding Average 12/3= 4 Very Satisfactory . of Employees = 5 Average ratings of staff Rating Division B Numerical Adjectival Division B Rating Employee 1 Employee 2 Employee 3 Employee 4 No.

Performance Rewarding and Development Professional Development Plan Date: Target Date Review Date Achieved Date Aim Objective Task Next Step Comments Discussed with: Date: Prepared by: Date: Employee Supervisor .

(Form J) Development Next Step Approved by: Date: Head of Office .