PERFORMANCE EVALUATION TOOL

COMMUNITY HEALTH PRACTICE

5 4 3 2 1
I Knowledge and Understanding
1. Basic knowlwdge of:
1.1 Basic Anatomy and Physiology
1.2 Primary Health Care
1.3 Care of Infant and Children/IMCI
1.4 Family Planning
1.5 Communicable Diseases
1.6 Nutrition
1.7 Antepartum Care
1.8 Postpartum Care
1.9 Neo/Infant Care
1.10 Under Five Clinic
a. Early Childhood Care & Development
b. Immunization (NIP)
II Skills:
1. Community Health Process
a. Conduct's Community assessment correctly
b. Interprets & analyze data gather correctly
2. Family Health Assessment:
a. Motivate Family for Case Study
b. Develops Family Health Care Plan
3. Performing Bag Technique correctly and sequentially
4. Renders Health Service through HOME VISITS:
A. Perform Antepartum Care
1. Commpute EDC, AOG, & BMI correctly
2. Takes Vital Signs accurately
3. Does Physical Assessment Thoroughly
4. Take Fundic Height measurement correctly
5. Does Leopold's Maneuver with proper body
mechanism and accurate result.
6. Locate/counts the fetal heart beat accurately.
7. Give instruction on:
Importance of Prenatal Care
Nutrition
Hygiene
Danger signs of pregnancy
Birth Plan
B. Perform Neo/Infant Care
1. Does cord care aseptically
2. Takes baby's weight accurately
 3. Takes baby's temperature accurately
4. Does physical assessment thoroughly
5. Perform partial/tub bath correctly
C. Perform postpartum care:
1. Take vital sign accurately
2. Does physical assessment thoroughly
3. Palpates/determine fundal descends correctly
5. Give instruction on:
5.1 Nutrition
5.2 Hygiene
5.3 Breastfeeding
5.4 Newborn Care
5.5 Newborn Screening
5.6 Well baby check-up & Immunization
5.7 Family Planning
D. Participates in Health Center/Liying-In Activities:
1. Health Care Activities:
a. Conducts Mother Class
b. Does Prenatal/postnatal Care Correctly
c.Does immunization aseptically and Correctly
2. Lying-In Activities:
a. Handle Delivery with Correct Technique
b. Provide Immediate newborn care correctly
3. Records/ chart on the following form correctly:
a. Servey Form
b. Antepartum
c. Neo/Infant (IMCI II Form)
d. Post Partum
e. Family Health Care Plan
f. Summary of Parturition
III 1. Attitude Towards:
1.1 Clients
1.2 Staff/Peer
1.3 Criticism/Correction/Problem
2. Personality Traits:
2.1 Grooming
2.2 Resourcefulness
2.3Honesty
2.4 courtesy
3. Submits Requirement on Time:
3.1 Daily Activities
3.2 Family Care Plan
3.3 Family Care Narrative
3.4 Community Health Practice Duccumentation
Comments:
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(Student’s Signature) (CI’s Signature)

Rating Scale:
4–5 - Excellent = 91% - 95%
3 – 3.99 - Very Satisfactory = 86% - 90%
2 – 2.99 - Satisfactory = 81% - 85%
1 – 1.99 - Fair =75% - 80%
Bellow .99 - Need Improvement =74%