DOH - SPMS Form 1 Document Code:

INDIVIDUAL PERFORMANCE COMMITMENT AND REVIEW (IPCR) Revision No.:

Effectivity:

I, _____OLIVER JERMAINE B. OCAMPO___, Nurse II , under the DOH HRH Deployment Program, commits to deliver and agree to be rated on the attainment of the following targets in accordance with the indicated
measures for the period June - December, 2019.

Name & Signature of HRH: ______________________________________________________ Date: _____________________________

Approved By: Date:

_________________________________________________________________
Name & Signature of Supervisor (DMO)

Actual
Accomplishment Rate RATING
Accomplishment Remarks/ Justification of Unmet Targets
Strategic Goals and Objectives Success Indicators and Target (Actual Accomplishment (e)
(c) (use separate sheet if needed)
(a) (b) ÷ Target x 100%)
Q E T A (f)
2nd semester (d)
(1) (2) (3) (4)

Strategic Functions (40%)

Notes:
* HRH may conduct family profiling 3 days in
10 families profiled per day or a week; remaining 2 days shall be for provision of
360 families completely profiled by end of health services in their assigned health facility
December, 2019 (BHS) ** The
total 360 families is computed based on 10/day X 3
days X 4 weeks X 3 months

Average Rating (Strategic Functions) #REF!

Core Functions (50%)
80% of families visited for the identification and
provision of appropriate health interventions on 0.00
health concerns/problems

To ensure efficiency on the provision of 80% of families provided with health education, 0.00
technical assistance to LGUs and other teachings, advocacies
health partners towards the achievement
of UHC 80% of clients provided with needed health * Means of Verification = LGU reports, HRH
0.00
services Journal / Monthly Accomplishments
100% (80%) of school children with consent
were immunized with Measles and other 0.00 * Refer to school based immunization guidelines
vaccines

100% (80%) of health emergencies (events, * Means of Verification = ESR, CRF, CIF, HEARS,
0.00
reportable diseases) reported within 24 hours HRH Journal / Monthly Accomplishments
To ensure the provision of immediate
investigation on outbreaks in identified 100% (80%) of AEFIs reported within 24 hours * Means of Verification = ESR, CRF, CIF,
0.00
populations HRH Journal / Monthly Accomp.
 Actual
Accomplishment Rate RATING
Accomplishment Remarks/ Justification of Unmet Targets
Strategic Goals and Objectives Success Indicators and Target (Actual Accomplishment (e)
(c) (use separate sheet if needed)
To ensure the provision
(a) of immediate (b) ÷ Target x 100%)
investigation on outbreaks in identified Q E T A (f)
2nd semester (d)
populations (1) (2) (3) (4)

100% (80%)of reported events responded/ * Means of Verification = ESR, CRF, CIF,
0.00
acted-upon HRH Journal / Monthly Accomp.

To ensure the provision of timely and * 6 complete monthly reports submitted every Monthly reports - refer to M1 (BHS report) being
0.00
accurate data and reports 2nd week of succeeding month submitted monthly to RHU
Average Rating (Core Functions) 0.00
Support Functions (10%)
To adequately provide admin.support * 100% of required / scheduled meetings * MOVs = Meetings documents
0.00
services attended / facilitated (attendance & minutes)
Average Rating (Support Functions) 0.00
FINAL AVERAGE RATING (g)
Adjectival Rating
Function % Distribution Scores Remarks
(h)
Strategic Functions 40% #REF!
Core Functions 50% 0%
Support Functions 10% 0%
Total Score
Prepared by (i): Validated / Approved by: (j) Date:

Name & Signature of HRH Name & Signature of Supervisor (DMO)

For PHTO use, do not fill-up columns (k) & (l)
Assessed by (k): Date:

AO / Prov'l. PMT Secretariat PHTL, Chairperson, Provincial PMT

Legend: 1- Quality 2 -Efficiency 3 - Timeliness 4 - Average
Instructions:
a - Strategic goals and objectives
a - Strategic goals and objectives - state the strategic goals & objectives aligned to agency mandate / thrusts
b - Specify the success indicator and the overall target for the said indicator. Please use the target and unit of measure specified in the list of basic indicators for each office category. Success indicators must be grouped depending on the office function it
intends to measure.
e1, e2, e3 - Indicate the rating (within the range of 1 - 5) based on the specified rating scale for each indicator and performance category. Only applicable rating fields must be filled up. Indicate NA if not applicable.
e4 - Compute the average of the quality, efficiency and timeliness ratings of each indicator.
f - Indicate remarks or justification for underachievement of the target, if applicable. Use separate sheet if needed.
g - The final average rating is equivalent to the sum of the final ratings of the Core, Support and Strategic function.
h - Indicate the adjectival rating scale which corresponds to the Final Average Rating of the Individual Employee
i - Name and signature of the office's staff who prepared the IPCR form.
j - Name and signature of the supervisor who validated and approved the IPCR the personnel.
k - Name and signature of PHTO Staff/ Secretariat who reviewed and validated the IPCR.
l - Name and signature of the PPMT Chair. Please do not fill this up; for PHTO use.