INDIV

I, (NAME), of the DOH - Regional Office VI assigned at (AREA OF ASSIGNMENT), com

Approved By:

SUCCESS INDICATOR
Output
(Targets + Measure)
100 % of actual clients served for........

Hematology
Parasitology
Clinical Microscopy
Clinical Chemistry
Serology
Laboratory Services Rendered

Bacteriology ( Smearing etc)

 Maintain cleanliness of working area,
equipment, etc

Quality Control
Cleanliness and Maintenance

Temperature monitoring of refrigerator and

laboratory

Check Supplies
Inventory and Monitoring of
Reagents and Supplies
 Reagents and Supplies

On-time Procurement of Supplies

Encode and Update of Keeping the logbook up to date

Laboratory Data
*log all results before end of the day
Report from 8 am to 5 pm from Monday to
Attendance in Station
Friday

6 meetings with 1 meeting per month for

Attendance to Meetings Monitoring, Validation, and Analysis of
Clinical Laboratory Outputs

Reflects the correct and logbook based

Daily Time Records entries of all working days within the month
concerned

Report actual monthly accomplishments.

Narrative Accomplishment
Submission of report three days prior the
Report
end of the month.

Attendance and Assitance to Various Health

Other Activities
Activities/ Programs

Total Overall Rating

Final Average Rating
Adjectival Rating
Comments and Recommendations for Development Purposes
Discussed with: Assessed by:
I certify that I discussed my performance
assessment with the employee

Employee Supervisor
Legend: 1- Quantity 2 -Quality 3 - Timeliness 4 - Average
 INDIVIDUAL PERFORMANCE COMMITMENT AND REVIEW (IPCR)
EA OF ASSIGNMENT), commit to deliver and agree to be rated on the attainment of the following targets in accorda

R
ACTUAL ACCOMPLISHMENT
QTY (1)
easure)
ved for........

Actual Number of clients served

with accuracy and efficiency on
duty schedule; please indicate 3 - Served 100% of actual clients
turn around time (usually 2
hours)
c)
 Justify if you were able to
f working area, maintain cleanliness of working
3
area, equipments, etc (Ideally,
clean before and after shift)

Perform Quality Control prior to

start of shift and for every new 3
lot no of reagents

Check and monitor temperature

refrigerator and of refrigerator and laboratory
3
every shift (Must be between 2-6
degrees Celcius)

5 – Performed more than 8 inventories

4 – Performed 7 – 8 inventories
Inventory of Supply - monthly (6 3 – Performed 6 inventories
inventories in total) 2 – Performed 3 – 5 inventories
1 – Performed less than 3 inventories
 Procurement of supplies if stock
upplies
reaches 50% of the total supply

date

of the day
m from Monday to

ng per month for

Meeting with MHO and other
and Analysis of
staff....... DMO IV, KP PP
y Outputs

d logbook based
s within the month

ccomplishments.
ee days prior the
onth.

to Various Health Identify Activity attended and

grams roles performed

s
Date Final Rating by:
discussed my performance
he employee

Supervisor Provinc
 DOH - SPMS Form 3
D REVIEW (IPCR)
ollowing targets in accordance with the indicated measures for the period April 11 to June 30, 2016.

Date: 07/01/2016

Date

5 – Outstanding
4 – Very Satisfactory
3 – Satisfactory
2 - Unsatisfactory
1 - Poor

RATING
Remark
A s
EFFICIENCY (2) T (3)
(4)
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5 – no error #DIV/0!
4 – with 1-2 minor errors in in pre-ana, #DIV/0!
ana, and post-ana
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3 – with 2 major errors in pre-ana, ana,
and post-ana #DIV/0!
2 – with 3 minor errors in pre-ana, ana,
and post-ana
1 – with 3 major errors in pre-ana, ana, #DIV/0!
and post-ana
5 – Infection control procedure properly
observed daily
4 – Infection control procedure
frequently observed (thrice a week)
3 – Infection control procedure seldom
observed (twice a week) BLANK 3.0000
2 – Infection control procedure rarely
observed (once a week)
1 – Infection control procedure
observed as needed

5 – QC performed properly
(Perform Normal and Abnormal
Control, Calibrate Machine) and
during every shift
4 – Failed to perform QC once
3 3.0000
3 – Failed to perform QC twice
2 – Failed to perform QC more
than three times
1 – No QC performed

5 – Checked and monitored

temperature every shift
4 – Failed to check and monitor
temperature once
3 – Failed to check and monitor
temperature twice
3
2 – Failed to check and monitor
temperature more than three
times
1 – Never checked or monitored
temperature

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BLANK

6 0 #DIV/0!
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Provincial DOH Officer