SAINT FRANCIS DOCTORS’ MEDICAL AND DIAGNOSTIC FACILITY

Masterson Avenue, Upper Canitoan, Cagayan de Oro City, 9000

Email address: saintfrancis.admn @gmail.com
: 0917-321-5246

PERFORMANCE EVALUATION FORM

SCORE OF RATING:
EXCELLENT: Performance significantly exceeds all expectations and targets. 96 - 100
ABOVE AVERAGE: Performance is above the range of expectations. 86 - 95
AVERAGE: Performance is within the range of expectations for the position. 75 - 85
BELOW AVERAGE: Performance is below the standard or range of expectations. 71 - 74
POOR: Performance is below all expectations and targets. 70 & below
Note: The employee who have three (3) consecutive failed performances is subject for:
 First - Warning (re-evaluate, re-test and re-orient).
 Second - Last Warning (suspension).
 Third – Dismissal.

NAME OF EMPLOYEE (EVALUATEE)

POSITION/ TITLE
DATE HIRED
DEPARTMENT/ LOCATION
DATE OF EVALUATION
RATING PERIOD

NO. ATTITUDE AND COMMITMENT RATING WEIGHTED

(%) SCORE
1 Dedicated to fulfilling job responsibilities.
2 Demonstrates good customer service skills.
3 Serves as a role model to others.
4 Exceeds expectations on his/her job description.
5 Maintains an appropriate and neat personal appearance and dress.
6 Professional demeanor.
7 Conscientious, honest, hard-working.
8 Exemplify Beyond Healthcare service to patients & clients.

NO. JOB PERFORMANCE RATING WEIGHTED

(%) SCORE
1 Knowledgeable of Saint Francis Doctors’ policy and procedure.
2 High overall quality of performance.
3 Accurately completes work assignments on time.
4 Controls high stress situations tactfully and calmly.
5 Takes initiative.
6 Requires little supervision.
7 Willingness to learn and take on new responsibilities.
8 Ability to train others and gladly willing to do so.
9 Shows Personal Care and service to patients and guests.

NO. INTERPERSONAL SKILLS RATING WEIGHTED

(%) SCORE
1 Displays a helpful, cooperative, and positive attitude
towards superiors and co-workers.
2 Consistently friendly and available to others.
3 Uses effective listening skills.
4 Has a team player attitude
5 Voluntarily assists co-workers in order to complete important
department projects.
6 Competent.

SFDH-HRD-QDF-012
 SAINT FRANCIS DOCTORS’ MEDICAL AND DIAGNOSTIC FACILITY
Masterson Avenue, Upper Canitoan, Cagayan de Oro City, 9000
Email address: saintfrancis.admn @gmail.com
: 0917-321-5246

NO. PUNCTUALITY RATING WEIGHTED

(%) SCORE
1 Must be in good standing and maintains TCMCI policy on
timeand attendance.
2 Observe generally agreed work break / meal period.
3 Start and finishes according to approved schedule.
4 Calls to explain absence.
5 Recognized as Perfect Attendance of the month.

NO. TEAMWORK RATING WEIGHTED

(%) SCORE
1 Works well with supervisors, peers, and subordinates.
2 Sets an example with a positive and supportive attitude.
3 Communicates well with coworkers and supervisors.
4 Promotes teamwork in the workplace.

NO. OTHERS RATING WEIGHTED

(%) SCORE
1 Practices proper safety procedures.
2 Establishes positive relations inter/intra departmentally.
3 Assumes additional responsibilities when needed.
4 Properly selects priorities.
5 Makes suggestions on better ways of getting work done.
6 Judgement and decision – making.
7 Adaptability.
8 Problem solving.

Comments: (required to answer)

Is the employee qualified for regularization? [YES] [NO]

If no, what is your recommendation?
_____________________________________________________________________________________
_____________________________________________________________________________________

Sum of Rating
Weighted Score (Sum of Rating Divided by 6)
Total Weighted Score

Signature of Evaluator: Date:

This form must be done after you received and returned to the Human Resource Development
Department. Thiswill become part of his/her 201 files.

FOR HRD USE ONLY:

Evaluation received on:_______________________ Time: _______________________

SFDH-HRD-QDF-012