Republic of the Philippines

Department of Health
SAN LAZARO HOSPITAL
Manila, Philippines

CERTIFICATION

This is to certify that CLARISSA STAR MERCADO SABIDO, assigned in MAIN LABORATORY,
has been employed since July 26, 2017 up to present.

Further certify that she has undergone COVID-19 antigen and RT-PCR swab test last
October 1, 2022 at San Lazaro Hospital and tested positive for both. She was advised to undergo
home quarantine until October 10, 2022 and reported for duty the following day, October 11.

This certification is issued to support her application for financial assistance with the
Government Service Insurance System (GSIS) and Employee Compensation Commission (ECC).

FRANCIS ENRIQUE R. VILLAR, RPh, MD, DPCOM

EMC, Physician on Duty

RAMON R. ISCALA, MBA

Supervising Administrative Officer

LEAH S. CATALAN
Supervising Administrative Officer
Head, HRMD

Kanlungan ng maysakit… Serbisyong may puso…

 Republic of the Philippines
Department of Health
SAN LAZARO HOSPITAL
Manila, Philippines

I. APPLICATION IN THE WORKPLACE

1. How will you apply the significant learnings gained from the LDI to your workplace?

2. What methods will you use in the dissemination of the learnings you gained?

Develop plan on (pls. specify)

Develop publication on (pls. specify)
Issue policy on (pls. specify)
Conduct campaign on (pls. specify)
Conduct training/workshop/ forum on (pls. specify)
Agenda on Technical Staff/Management/Executive Committee Meeting
Kanlungan ng maysakit… Serbisyong may puso…
 Republic of the Philippines
Department of Health
SAN LAZARO HOSPITAL
Manila, Philippines
Others (pls. specify)

II. RATING/RECOMMENDATIONS:

A. RATING - Rate the Facilitation of the Company/Agency who conducted or sponsored the External Learning and Development
Intervention
Very dissatisfied Dissatisfied Neutral Satisfied Very Satisfied
TECHNICAL
(e.g. speaker, topic)

ADMINISTRATIVE
(e.g. travel arrangement, hotel,
accommodation)

B. RECOMMENDATIONS:
What are your recommendation about the External Learning and Development Intervention attended?

Pursue regular conduct/attendance Select more appropriate person next time

Participate if held Participation not recommended
Increase number of delegates Others (pls. specify)

Prepared by: Noted by:

Signature over printed name (Participant) Signature over printed name (Immediate Supervisor)
_________________________________________________________________________________________
PLEASE DO NOT FILL-UP FOR PETDO USE ONLY:
REACTION LEARNING BEHAVIOR RESULTS RETURN OF
EXPECTATION
PERIOD OF
MONITORING
COMMENTS/
OBSERVATION

_______________________________________________
(PRINTED NAME OVER SIGNATURE OF TRAINING OFFICER)

Kanlungan ng maysakit… Serbisyong may puso…