PERFORMANCE MONITORING SHEET

January 1 to June 30, 2022

(Period covered/ Month and Year)

Name: MARIA TERESA J. ANDRADE Position: Nurse II

MFO Tasks Assigned Duration Task status/

Remarks
January to
Assess and assist patients for Assessed and assisted _____
June 2022 Task completed
consultation patients for consultation
January to
Carry out doctors order and Carried out ____ doctors order
June 2022 Task completed
nursing intervention and nursing interventions
Documented ____treatment January to
Document treatment and
and procedures performed to June 2022 Task completed
procedure performed to patients
patients
Conduct health promotion ____ health promotion activities
January to
activities and provide conducted and provided
June 2022 Task completed
information on disease information on disease
prevention prevention
January to
Monitor nursing staff on 100% monitored nursing staff on
June 2022 Task completed
Infection Control Program Infection Control Program
January to
Prepares and submit 6 Accomplishment report
June 2022 Task completed
accomplishment report prepared and submitted
No seminars/
Report Preparation trainings
attended
100% Daily Time Record of
January to
CNPH employee properly
Submission of Daily Time Record June 2022 Task completed
accomplished and submitted to
payroll clerk 4 days upon receipt
January to January to
100% of flag ceremony conducted
Attend Flag Ceremony June 2022 June 2022
attended

Reviewed by:

VENUS D. MANLAPAZ, RN, MAN

Nurse V/Chief Nurse
 PERFORMANCE MONITORING SHEET

January 1 to June 30, 2022

(Period covered/ Month and Year)

Name: ___________________________ Position: Nurse I

MFO Tasks Assigned Duration Task status/

Remarks
January to June,
Assess and identify emergency ____ patients assessed and Task
2022
needs of patient identified their emergency needs completed
January to June,
Admits and endorse patient to ____ patients admitted and Task
2022
ward nurse endorsed to ward nurse completed
January to June,
____ patients vital signs were Task
Take and record vital signs 2022
taken and recorded completed
January to June,
Attend emergency cases and 100% of emergency cases and Task
2022
consultations consultations attended completed
January to June,
____ doctor’s order were carried Task
Carry out doctors order 2022
out completed
Completely documented January to June,
Document patient data and Task
____patients data and nursing 2022
nursing care done completed
care done during the shift
January to June,
Prepare and assist patients for ____ patients prepared and Task
2022
special procedures assisted for special procedures completed
January to June,
Provide health teachings to 100% provided health teachings Task
2022
patients and watchers to patients and watchers completed
Maintain proper care of 100% maintained proper care of January to June,
Task
equipment and cleanliness equipment and cleanliness and 2022
completed
and orderliness of the ward orderliness of the ward.
January to
Prepares and submit 6 Accomplishment report Task
June, 2022
accomplishment report prepared and submitted completed
No seminars/
Report Preparation trainings
attended
100% Daily Time Record of CNPH
January to June,
Submission of Daily Time employee properly accomplished Task
2022
Record and submitted to payroll clerk 4 completed
days upon receipt
January to
100% of flag ceremony conducted Task
Attend Flag Ceremony June 2022
attended completed

Reviewed by:

VENUS D. MANLAPAZ, RN, MAN

Nurse V/Chief Nurse
 PERFORMANCE MONITORING SHEET

January 1 to March 31, 2024

(Period covered/ Month and Year)

Name: HILDA P. TAN Position: Nursing Attendant II

MFO Tasks Assigned Duration Task status/

Remarks
Receive/admit patient and make 261 patients received/ admitted January to
rapid assessments of the and made rapid assessments of March, 2024 Task completed
condition the condition
January to
Monitor vital signs 258 vital signs monitored March, 2024 Task completed

January to
Document findings of patient 436 findings of patient condition
March, 2024 Task completed
condition documented
January to
Carry out doctor’s order 436 doctors order carried out March, 2024 Task completed

144 patients prepared for January to

Prepare patients for examination
examination and special March, 2024 Task completed
and special procedures
procedures
January to
Attend deliveries 238 deliveries attended Task completed
March, 2024
January to
Provide newborn care Provided 238 newborn care Task completed
March, 2024
January to
Facilitate referrals 255 referrals facilitated Task completed
March, 2024
Provide health teaching to 100% provided health teaching to January to
Task completed
patients and/or watchers patients and/or watchers March, 2024
Prepare charge slips for supplies 255 charge slips for supplies used
January to
used during delivery and attach a during delivery prepared and Task completed
March, 2024
copy in the chart attached a copy in the chart
Endorsed 1,415 patient to ward
January to
Endorse patient nurse and/or incoming shift Task completed
March, 2024
nurses/NAs
Provide complete home 1,415 discharged patients
January to
instructions of discharged provided with complete home Task completed
March, 2024
patients instructions
Prepares and submit 6 Accomplishment report January to
Task completed
accomplishment report prepared and submitted March, 2024
No seminars/
Report Preparation
trainings attended
100% Daily Time Record of CNPH
January to
employee properly accomplished
Submission of Daily Time Record March, 2024 Task completed
and submitted to payroll clerk 4
days upon receipt
100% of flag ceremony conducted January to
Attend Flag Ceremony Task completed
attended March, 2024

Reviewed by:

JENNELYN V. MASAGCA, RN, MAN

Nurse III/Acting Chief Nurse
 PERFORMANCE MONITORING SHEET

January 1 to March 31, 2024

(Period covered/ Month and Year)

Name: MARILOU A. RAMORES_ Position: Nursing Attendant II

MFO Tasks Assigned Duration Task status/

Remarks
Receive/admit patient and make ____ patients received/ admitted January to
rapid assessments of the and made rapid assessments of March, 2024 Task completed
condition the condition
January to
Monitor vital signs ____ vital signs monitored March, 2024 Task completed

January to
Document findings of patient ___ findings of patient condition
March, 2024 Task completed
condition documented
January to
Carry out doctor’s order ____ doctors order carried out March, 2024 Task completed

____ patients prepared for January to

Prepare patients for examination
examination and special March, 2024 Task completed
and special procedures
procedures
January to
Attend deliveries ____deliveries attended Task completed
March, 2024
January to
Provide newborn care Provided ____newborn care Task completed
March, 2024
January to
Facilitate referrals ____ referrals facilitated Task completed
March, 2024
Provide health teaching to 100% provided health teaching to January to
Task completed
patients and/or watchers patients and/or watchers March, 2024
Prepare charge slips for supplies ____charge slips for supplies used
January to
used during delivery and attach a during delivery prepared and Task completed
March, 2024
copy in the chart attached a copy in the chart
Endorsed ____patient to ward
January to
Endorse patient nurse and/or incoming shift Task completed
March, 2024
nurses/NAs
Provide complete home
____discharged patients provided January to
instructions of discharged Task completed
with complete home instructions March, 2024
patients
Prepares and submit 3 Accomplishment report January to
Task completed
accomplishment report prepared and submitted March, 2024
No seminars/
Report Preparation
trainings attended
100% Daily Time Record of CNPH
January to
employee properly accomplished
Submission of Daily Time Record March, 2024 Task completed
and submitted to payroll clerk 4
days upon receipt
100% of flag ceremony conducted January to
Attend Flag Ceremony Task completed
attended March, 2024

Reviewed by:

JENNELYN V. MASAGCA, RN, MAN

Nurse III/Acting Chief Nurse

PERFORMANCE MONITORING SHEET

 January 1 to June 30, 2022
(Period covered/ Month and Year)

Name: ____________________________ Position: ____________

MFO Tasks Assigned Duration Task status/

Remarks
January to
Attend endorsement Completely attended ___
June, 2022 Task completed
completely endorsements
January to
___ patients admitted within
Admits Patient June, 2022 Task completed
the shift
Attend and assist patient with 100% Attended and assisted
January to
their needs and render patient with their needs and
June, 2022 Task completed
immediate nursing rendered immediate nursing
interventions interventions
January to
Carry out doctors order ___ doctors order carried out June, 2022 Task completed

January to
Document patient care ____ of patient care performed
June, 2022 Task completed
performed documented
100% provided health teaching January to
Health teaching Task completed
to patients and/or watchers June, 2022
Provide complete home ___ discharged patients
January to
instructions of discharged provided with complete home Task completed
June, 2022
patients instructions
Prepares and submit Accomplishment report January to
Task completed
accomplishment report prepared and submitted June, 2022
No seminars/
Report Preparation
trainings attended
100% Daily Time Record of CNPH
January to
employee properly accomplished
Submission of Daily Time Record June, 2022 Task completed
and submitted to payroll clerk 4
days upon receipt
January to
100% of flag ceremony conducted
Attend Flag Ceremony June 2022 Task completed
attended

Reviewed by:

VENUS D. MANLAPAZ, RN, MAN

Nurse V/Chief Nurse
 PERFORMANCE MONITORING SHEET

January 1 to June 30, 2022

(Period covered/ Month and Year)

Name: _______________________ Position: _____________

Task status/
MFO Tasks Assigned Duration
Remarks
Receive patient and check the
_____ patients received and January to
chart if all pre-op
checked the charts if all pre-op June, 2022 Task completed
requirements are
requirements are administered
administered
Strictly observe aseptic
Strictly observed aseptic technique January to
technique in preparation of
in preparation of ____ patients June, 2022 Task completed
patient operative site for
operative site for surgery
surgery
Provide safe physical Provided 100% safe physical January to
environment, equipment and environment, equipment and June, 2022 Task completed
supplies during operation supplies during operation
Assume responsibility for Assumed 100% responsibility for January to
correct count of sponges, correct count of sponges, June, 2022 Task completed
instruments and needles instruments and needles
January to
Maintain accurate and Maintained 100% accurate and
June, 2022 Task completed
complete records of vital signs completed records of vital signs
January to
Assist and anticipate the needs 100% assisted and anticipated the
June, 2022 Task completed
of surgeon during operation needs of surgeon during operation

Prepare instruments and 100% of instruments and supplies January to

supplies according to specified prepared according to specified June, 2022 Task completed
order and to type of operation order and to type of operation
January to
Assisted in transporting ____ patient assisted in transporting
June, 2022 Task completed
patient to recovery room to recovery room
January to
Provide health teachings to 100% provided health teachings to
June, 2022 Task completed
significant others significant others
January to
Request supplies and packs for ____ times requested supplies and
June, 2022 Task completed
OR use packs for OR use
January to
Maintain cleanliness and Maintained 100% cleanliness and
June, 2022 Task completed
orderliness of the area orderliness of the area
January to
Prepares and submit 6 Accomplishment report prepared
June, 2022 Task completed
accomplishment report and submitted
month
No seminars/
Report Preparation trainings
attended
100% Daily Time Record of CNPH
January to
Submission of Daily Time employee properly accomplished
June, 2022 Task completed
Record and submitted to payroll clerk 4
days upon receipt
January to
100% of flag ceremony conducted
Attend Flag Ceremony June 2022 Task completed
attended

Reviewed by:

VENUS D. MANLAPAZ, RN, MAN

Nurse V/Chief Nurse

PERFORMANCE MONITORING SHEET

 January 1 to June 30, 2022
(Period covered/ Month and Year)

Name: TERESA F. JACELA Position: Nurse I

MFO Tasks Assigned Duration Task status/

Remarks
Operate autoclaves and Operated autoclaves and
other electrical devices other electrical devices used in January to
June, 2022
Task
used in cleaning and cleaning and sterilizing
completed
sterilizing equipment and equipment and supplies
supplies _____times
Assembled and prepared
Assemble and prepare
packs, trays and other
packs, trays and other January to
equipment and supplies and June, 2022
Task
equipment and supplies
prepared such sterilized completed
and prepare such sterilized
supplies for ready use 858
supplies for ready use
times
Assist in ascertaining need 100% assisted in ascertaining
for additional or modified need for additional or
January to
services, supplies and modified services, supplies June, 2022
Task
equipment needed in all and equipment needed in all completed
clinical areas and other clinical areas and other
department of the hospital department of the hospital
Keep inventory records of 100% kept inventory records
January to
items used and maintain of items used and maintained June, 2022
Task
schedule of charges for all schedule of charges for all completed
chargeable items chargeable items
January to
Prepares and submit 6 Accomplishment report June, 2022
Task
accomplishment report prepared and submitted completed
No seminars/
Report Preparation trainings
attended
100% Daily Time Record of
CNPH employee properly January to
Submission of Daily Time June, 2022
Task
accomplished and submitted
Record completed
to payroll clerk 4 days upon
receipt
January to
100% of flag ceremony conducted
Attend Flag Ceremony June 2022 Task completed
attended

Reviewed by:

VENUS D. MANLAPAZ, RN, MAN

Nurse V/Chief Nurse