SAN LAZARO HOSPITAL
INDIVIDUAL PERFORMANCE COMMITMENT AND REVIEW (IPCR)
I, PEACHY A. TIONLOC,RLT,Medical Laboratory Technician III of the LABORATORY DEPARTMENT, commit to deliver and agree to be rated on the attainment of the following targets in accordance with the
indicated measures for the period JULY TO DECEMBER, 2022
Approved By:
Output
Pre-Analytical Phase:
a.)Specimen collection
b.)Verification of
laboratory requests and
specimens
c.)Rhivda assistance
Analytical Phase:
FM-HOPSS-HRMD-028
Date Effective: September 1, 2018, Rev. 0
11-Jan-23
Signature of Employee Date Signed
Date
5 – Outstanding
Elizabeth Freda O. Telan,MD, PhD 4 – Very Satisfactory
3 – Satisfactory
2 - Unsatisfactory
1 - Poor
RATING
Success indicator
(Target + Measure)
Actual Accomplishment Remarks
Q (1) E (2) T (3) A (4)
perform 100% of assigned
performed 100% (1600/1600) of assigned specimen
specimen collection on patients
collection on patients within 30mins per patient with no 5 5 3 4.33
within 30mins per patient with no
error
error
verify and check-in 100% of verified and checked-in 99% (1296/1300) of assigned
assigned laboratory requests within laboratory requests within 5 mins per request with no 5 4 3 4.00
5 mins per request with no error error
verify and barcode code 100% of verified and barcoded 100% (1300/1300) of assigned
assigned patient specimens within patient specimens within 5 mins per request with no 5 5 3 4.33
5 mins per request with no error error
encode 100% of assigned patient's
encoded 100% (200/200) of assigned patient's info for
info for HOMIS within 5mins per 5 5 3 4.33
HOMIS within 5mins per request with no error.
request with no error.
examined and analyzed 100%
examined and analyzed 100% (1000/1000) assigned
assigned specimens within 5 5 3 4.33
specimens within prescribed TAT with no error
prescribed TAT with no error

Submission of Reports
RATING
Total Overall Rating
Final Average Rating
Adjectival Rating
Comments and Recommendation for Development Purposes
prepare and submit 100% of
required accomplishment report prepared and submitted 100% of required
within 24 hours after every workshift accomplishment report within 24 hours after every 5 5 3 4.33
with no negative feedback from workshift with no negative feedback from Chief MT
Chief MT
prepare and discuss 100% of work
prepared and discussed 100% of work endorsements
endorsements within 30 mins at the
within 30 mins at the end of workshift with no complaint 5 5 3 4.33
end of workshift with no complaint
from supervisor
from supervisor
25.50
4.25
VS

Discussed With: Assessed by: Date Reviewed By: Final Rating By: Date
I certify that I discussed my assessment of the perfomance
with the employee
Jose Benito R Villarama, MD,MPH,CSEE
11/1/2023
PEACHY A. TIONLOC, RLT EDITH S. TRIA, MD, FPSP Elizabeth Freda O. Telan,MD, PhD
Employee Supervisor Perf. Mngt. Team Division Chief Concerned
Legend: 1- Quality 2 - Efficiency 3 - Time 4 - Average

FM-HOPSS-HRMD-028
Date Effective: September 1, 2018, Rev. 0
 Pre-Analytical Phase:
a)Collected/picked-up patient
specimens
b) Verified laboratory requests (LIS-
check in)
c) Verified specimens (assigned
codes)
d) Transported specimens to SNL-
Analytical Section