ANNEX B - SUPERVISORY LEVEL EMPLOYEE

INDIVIDUAL PERFORMANCE COMMITMENT AND REVIEW (IPCR) FORM

I, FROILAN S. ARRIOLA, ADMINISTRATIVE AIDE VI (UTILITY FOREMAN) of the SCPH, commit to deliver and agree to be rated on the attainment of the following targets in accordance with
the indicated measures for the period January 01, 2021 to June 30, 2021.

FROILAN S. ARRIOLA
ADMINISTRATIVE AIDE VI (UTILITY FOREMAN)

Date: January 09, 2021

Reviewed by: Date Recommending Approval: Date Approved by: Date

RODITT C. DELFINO CONRADO M. BRAÑA, JR., MD, MHA, FPCHA, CEO VI

Immediate Supervisor Next Higher Supervisor Head of Office

RATING
SUCCESS INDICATORS
MFO / PAP ACTUAL ACCOMPLISHMENTS E T REMARKS
(TARGETS + MEASURES) EQ Total A
NF F NF F
CORE FUNCTIONS
Administrative Support Management 100% administrative support service
provided as scheduled
100% of Mandatory reports submitted within
the set deadline (AIP, SOPA, OPCR, IPCR,
etc.)
INDIVIDUAL PRIMARY FUNCTIONS
Conduct hospital monitor and ensure 100% (255) times conducted hospital 100% (548) times conducted hospital 4 5 5 14 4.67
cleanliness of hospital surroundings and monitor and ensure clealiness of hospital monitor and ensure clealiness of hospital
premises surroundings and premises daily surroundings and premises daily
Facilitate disposal of hospital waste 100% (170) times facilitated disposal of 100% (395) times facilitated disposal of 5 5 5 15 5.00
hospital waste daily hospital waste daily
Ensures strict segregation of hospital 100% ensured strict segregation of hospital 100% ensured strict segregation of hospital 4 5 5 14 4.67
wastes and its disposal to collecting wastes and its disposal to collectiong wastes and its disposal to collectiong
agencies (PEMO, CENRO, ETC.) agencies (PEMO, CENRO, ETC.) as agencies (PEMO, CENRO, ETC.) as
scheduled scheduled
Prepared of schedule of duty for approval 6 times schedule of duty prepared for 6 times schedule of duty prepared for 5 5 5 15 5.00
approval as scheduled approval as scheduled
Supply inventory and prepare report of 100% (72) times inventory of supplies and 100% (255) times inventory of supplies and 4 5 5 14 4.67
janitorial supplies per issuance of supply prepared report of janitorial supplies per prepared report of janitorial supplies per
section issuances of supply section as scheduled issuances of supply section as scheduled

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 RATING
SUCCESS INDICATORS
MFO / PAP ACTUAL ACCOMPLISHMENTS E T REMARKS
(TARGETS + MEASURES) EQ Total A
NF F NF F
Conduct regular meetings 3 times monthly meetings conducted to 6 times monthly meetings conducted to 5 5 5 15 5.00
utility personnels as scheduled utility personnels as scheduled
Conduct monitoring and coaching to staff 100% (10) times conducted staff monitoring 100% (53) times conducted staff 5 5 5 15 5.00
and coaching as scheduled monitoring and coaching as scheduled
Monitor and evaluates staff performance 100% (27) staff monitored and evaluated 100% (54) staff monitored and evaluated 4 5 5 14 4.67
and activities performance and activities as scheduled performance and activities as scheduled
Submission, preparation and supervise 100% monitoring and coordination report 100% (154) monitoring and coordination 4 5 5 14 4.67
daily monitoring and coordination report prepared and submitted to supervisor as report prepared and submitted to supervisor
signed by CCM scheduled as scheduled
IPCR preparation, review and submission 100% (8) of staff IPCR's reviewed, 100% (53) of staff IPCR's reviewed, 5 5 5 15 5.00
as scheduled. evaluated & rated with CSR's & IDP evaluated & rated with CSR's & IDP
prepared as scheduled. prepared as scheduled.
Compliance to wearing of prescribed office 100 Individual Performance Commitment Preparation and submission of January to 5 5 5 15 5.00
uniform, wearing of ARTA ID and log in and and Review (IPCR) Preparation and June 2021 rated IPCR and July to
log out in the attendance logbook submission of July to December 2020 December 2021 Target IPCR with the
rated IPCR and January to June 2021 complete document attached on or before
Target IPCR with the complete document July 31, 2021
attached as scheduled
Ensure availability of orderly personnel in 100% ensure availability of orderly 100% ensure availability of orderly 5 5 5 15 5.00
transporting patient from one area to personnel in transporting patient from one personnel in transporting patient from one
another per request area to other area of the hospital as area to other area of the hospital as
necessary necessary
No. of IPCRs Rated and Pertinent 100% (5) IPCRs Rated and Pertinent 100% (6) IPCRs Rated and Pertinent 5 5 5 15 5.00
documents reviewed Documents reviewed as scheduled Documents reviewed as scheduled
HOSPITAL INFECTION PREVENTION AND 100% hospital infection prevention and 100% hospital infection prevention and 5 5 10 5.00
CONTROL IMPLEMENTATION control protocols complied (No Timeliness) control protocols complied (No Timeliness)
COVID 19 MANAGEMENT 100% COVID 19 Suspects, Probable and 100% COVID 19 Suspects, Probable and 5 5 10 5.00
Confirmed Patients Attended, Facilitated Confirmed Patients Attended, Facilitated
and Managed (No Timeliness) and Managed (No Timeliness)
RA 11032 COMPLIANCE 100% compliance to RA 11032 (No 100% compliance to RA 11032 (No
timeliness) timeliness)
Subtotal A (x80%) 210 4.89

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 RATING
SUCCESS INDICATORS
MFO / PAP ACTUAL ACCOMPLISHMENTS E T REMARKS
(TARGETS + MEASURES) EQ Total A
NF F NF F

OVERALL AVERAGE RATING (Output Evaluation) Total Overall Average Rating: Subtotal A 4.89
+ Subtotal B = 0.00 4.89
(Final Average Rating) Adjectival Rating: VS

Legend: E/Q - Effectiveness/Quality E - Efficiency (A) - For functions where targets can still be exceede (B) - For functions with fixed targets & cannot be possibly exceeded Total - (E/Q + E + T)
T - Timeliness (A) - For functions that can be accomplished ahead of schedule (B) - For functions with fixed schedule A - Average (Total / 3)

Comments and Recommendations: Rating Scale

5.00 - Outstanding
Discussed with: Date Assessed by: Recommending Approval: Approved: 4.00 - 4.99 - Very Satisfactory
3.00 - 3.99 - Satisfactory
2.00 - 2.99 - Unsatisfactory
FROILAN S. ARRIOLA RODITT C. DELFINO CONRADO M. BRAÑA, JR., MD, MHA, FPCHA,
1.00 - 1.99 - Poor
Employee Immediate Supervisor Next Higher Supervisor Head of Office

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