Republic of the Philippines BNK 2016

Form 3a
Department of Health
OFFICE OF THE SECRETARY
BAYANI NG KALUSUGAN
FINAL JUDGING – INDIVIDUAL CATEGORY - EVALUATION SHEET

INSTRUCTIONS: Finalists should be judged only by the criteria enumerated in the Official Evaluation
Form. Judge’s Rating should be within the recommended Rating Range. Judge has the prerogative not to
assign the maximum points to the Finalist.

FINALIST NAME JUDGE NAME

CRITERIA RATING RANGE JUDGE’S RATING

Excellence in Work / Impact of
Performance (20 points)
 Work beyond the call of duty to enhance the
health and well-being of the people or
community they serve (e.g. beyond statutory
requirements, corporate responsibilities, or
15 – 20
usual day to day operations). 15 –16 Good
17 – 18 Very Good
 Extent to which accomplishment/result is being
19 – 20 Outstanding
used
 Paradigm shift accomplishment has caused
and resources maximized/saved
 Extent to which accomplishment has efficiently
and effectively improved health performance
Leadership (20 points)
 Achievement/s has surpassed normal
expectations
 Health systems and processes have been
developed to improve, monitor safe/secure
healthcare provisions 15 – 20
 Achievement/s has increased awareness, 15 –16 Good
educated people, reached a wide number of 17 – 18 Very Good
stakeholders, involved co-operative efforts 19 – 20 Outstanding
between multiple people, community groups, or
organizations
• Challenges were overcome by
accomplishment/s
Commitment / Heroic Acts (40points)
 Exceptional, selfless dedication in achieving 30 – 40
universal health care
 Nominee’s dedication, self-motivation, 30 – 34 Good
discipline and effort in his/her/their 35 – 38 Very Good
achievements flowed to the community 39 - 40 Outstanding

Innovation (20 points)

 Degree of uniqueness and originality of 15 – 20
outstanding performance or contribution/s 15 –16 Good
 Accomplishment/work has contributed to 17 – 18 Very Good
improve health 19 – 20 Outstanding
 Innovation has contributed to the overall health
operations
TOTAL 75-100
I hereby declare that my decisions on the evaluation of this nominee was done in the utmost
objectivity, without any prejudice nor personal bias, and are solely based on the information
provided to me herewith.

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DATE EVALUATED SIGNATURE OF JUDGE