INDIVIDUAL PERFORMANCE COMMITMENT AND REVIEW FORM (IPCRF)

Name of Employee: Name of Rater :

Position : NURSE II Position :
RATING Period : JANUARY TO DECEMBER 2020 Date of Review :
Division :

TO BE FILLED IN DURING
TO BE FILLED IN DURING PLANNING
EVALUATION
WEIGHT/ PERFORMANCE INDICATOR Actual Rating
MFO KRA OBJECTIVES TIMELINE Final Score
KRA (Quality, Efficiency, Timeliness) Results Q E T Ave.
Health and > Conduct Individual health Jan. - Dec. 5 = 6, 000 and above pupils assessed for the whole year

Nutrition assessment of learners 2020 4 = 5, 001 - 5, 999 pupils assessed for the whole year
including those participating in
Services different 40% 3 = 4,000 to 5,000 pupils assessed for the whole year
2 = 3,000 - 4, 999 pupils assessed for the whole year
activities (scouting, sports, academic &

other extra curricular activities) 1 = 1,000 to 2,999 pupils assessed for the whole year

> Facilitate Deworming of learners Jan. and 5 = 6, 001 and above pupils assessed for the whole year

July 2020 4 = 5, 501 - 6, 000 pupils assessed for the whole year
10% 3 = 5, 000 - 5, 500 pupils assessed for the whole year

2 = 3, 000- 4, 999 pupils assessed for the whole year

1 = 1, 000 - 2, 999 pupils assessed for the whole year

> Conduct Health Assessment Jan. - Dec. 5 - 300 and above TP & non TP assessed annually

of teaching and non teaching 2020 4 - 200 - 299 TP & non TP assessed annually
personnel 10% 3 - 100 - 199 TP & non TP assessed annually

2 - 50 - 99 TP & non TP assessed annually

1 - 49 and below TP & non TP assessed annually

DEPED RPMS form – For Staff (below SG 18) | 3
 TO BE FILLED IN DURING
TO BE FILLED IN DURING PLANNING
EVALUATION
WEIGHT/ PERFORMANCE INDICATOR Actual Rating
MFO KRA OBJECTIVES TIMELINE Final Score
KRA (Quality, Efficiency, Timeliness) Results Q E T Ave.
> Treat pupils with minor Jan. - Dec. 5 - 1, 500 & above pupils treated annually
ailments/defects 2020 4 - 1, 000 - 1, 499 pupils treated annually
5% 3 - 500 - 999 pupils treated annually
2 - 200 - 499 pupils treated annually
1 - 199 & below pupils treated annually
> Refer learners,teaching and Jan. - Dec. 5 - 1, 500 & above pupils treated annually
non teaching to Medical Officer 2020 4 - 1, 000 - 1, 499 pupils referred annually
& other agencies for further 5% 3 - 500 - 999 pupils referred annually
treatment 2 - 200 - 499 pupils referred annually
1 - 199 & below pupils treated annually
> Monitor and Supervise 5 = 8 schools & above monitored and supervised
National Drug Education Program 4 = 6 -7 schools monitored and supervised
and Mental Health Program year round 5% 3 = 4 - 5 Schools monitored and supervised
2 = 2 - 3 schools monitored and supervised
1 = 1 school monitored and supervised
Health and > Conduct classroom/individual Jan. - Dec. 5 - 200 & above classroom health talks conducted
Nutrition health lectures 2020 4 - 151 - 199 classroom health talks conducted
Education 10% 3 - 100 - 150 classroom health talks conducted
2=- 50 - 99 classroom health talks conducted
1 = 49 & below classroom health talks conducted
DEPED RPMS form – For Staff (below SG 18) | 3
 TO BE FILLED IN DURING
TO BE FILLED IN DURING PLANNING
EVALUATION
WEIGHT/ PERFORMANCE INDICATOR Actual Rating
MFO KRA OBJECTIVES TIMELINE Final Score
KRA (Quality, Efficiency, Timeliness) Results Q E T Ave.
5 - 12 and above accomplished reports submitted and
RECORDING > Accomplish, fill, submit Jan. - Dec. disseminated all memos
4 = 11 times accomplished reports submitted and
AND and disseminate different 2020 disseminated all memos
reports and memoranda
5% 3 = 10 accomplished reports submitted and disseminated all
REPORTING memos
2 = 6 - 8 times accomplished reports submitted and
disseminated all memos
1 = 5 and below accomplished reports submitted and
disseminated all memos

DISTRIBUTION > Distribute Information, Education 5 = 4 and above distributed medicines and other medical
and Communication materials, Jan. - Dec. supplies
OF SUPPLIES, medicines and other medical 2020 4 = 3 times distributed medicines and other medical supplies
5%
AND supplies
3 = 2 times distributed medicines and other medical supplies
MATERIALS 2 = 1 time distributed medicines and other medical supplies
1 = no distribution of medicines and other medical supplies
LINKAGES > Attendance to inter/intra Jan. - Dec. 5= 5 times attended inter/intra agencies
agency meetings, conferences 2020 5= 4 times attended inter/intra agencies
and seminars 5% 3 = 3 attended inter/intra agencies
2= 2 times attended inter/intra agencies
2= 1 time attended inter/intra agencies
TOTAL 100%
OVERALL RATING FOR
ACCOMPLISHMENT
Rater Ratee Approving Authority

DEPED RPMS form – For Staff (below SG 18) | 3