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Region : III
Province : ZAMBALES
City :

INDIVIDUAL PERFORMANCE COMMITMENT AND REVIEW (IPCR)

I, FRANCIS R. ALMAZAN , ADMINISTRATIVE AIDE III , 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 to JUNE , 20 22 .

FRANCIS R. ALMAZAN
Ratee
Date :

REVIEWED BY : APPROVED BY: 5 – Outstanding


4 – Very
HON. HERMOGENES E.
Satisfactory
TRISHA MAE D. APSAY EBDANE, JR.
Governor 3 – Satisfactory
Administrative Officer V
Dat 2 -Unsatisfactory
Human Resource Section Head of Agency Date
e 1 – Poor

OUTPUT SUCCESS INDICATORS RATING REMARKS


ACTUAL ACCOMPLISHMENTS
( ACTIVITY ) ( TARGET + MEASURES ) Q1 E2 T3 A4
100% effectively transported
1. Transport patients to other hospital as per 95% transported patients to other hospital as per travel
patients to other hospital as per
travel order order effectively
travel order
2.Checks vehicles before and after travel 95% checked vehicle effectively 100% effectively checked vehicle
95% of reports of trip ticket, fuel, oil consumption, and 100% of reports of trip ticket, fuel, oil
3.Consolidates reports on trip tickets, fuel, oil
vehicle usage consolidated effectively consumption, and vehicle usage
consumption and vehicle usage
consolidated effectively

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Legend: 1 – Quantity 2 – Efficiency 3 – Timeliness 4 – Average
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100% effectively maintained


4. Maintenance of hospital ambulance 95% hospital ambulance cleanliness maintained
cleanliness of hospital
effectively
ambulance
COVID 19 SERVICE
100% effectively transported
1. Transport confirmed Covid 19 patients to 95% transported confirmed Covid 19 patients confirmed Covid 19 patients to
different quarantine facility and hospitals. quarantine to facility and hospitals effectively. quarantine facilities and
hospitals.
100% effectively cleaned and
2. Clean and disinfect vehicle including
95% cleaned and disinfected vehicle including disinfected vehicle including
stretchers and equipment used during
stretchers and equipment used during transport by stretchers and equipment used
transport by following standard operating
following standard operating procedures effectively. during transport by following
procedures.
standard operating procedures.
FINAL AVERAGE RATING
ADJECTIVAL RATING
Comments and Recommendation for
Development Purposes or Reward/Promotion :
Discussed with : Date : Assessed by : Date : Final Rating by : Date :
I certify that I discussed my assessment of the
performance with the employee.

FRANCIS R. ALMAZAN TRISHA MAE APSAY NOEL BUENO, MD


Administrative Aide III Administrative Officer V Provincial Health Officer II
Employee Human Resource Head of Office
Section

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Legend: 1 – Quantity 2 – Efficiency 3 – Timeliness 4 – Average

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