DEPARTMENT OF HEALTH

HEALTH HUMAN RESOURCE DEVELOPMENT BUREAU

COMPETENCY PROFICIENCY ASSESSMENT HOSPITALS

Competencies are behaviors that predict superior performance and success within a particular job or function.
Instructions
Read
Read the competency definition and each proficiency level. Note that levels are spread from Level A (lowest level) to Level E (highest level). Take a moment
to understand how the competency progresses from Level A to Level E. You may refer to the definition of each proficiency level for guidance on what behavior
is expected under each level.

Assess
Mark by shading the level of behaviors consistently manifested by the Incumbent. This is the highest level routinely achieved and could reasonably be
expected to be repeated on an ongoing basis. Please do not assess anticipated or desired behaviors, but rather behaviors that are consistently demonstrated
on the job.
Do not select a particular level unless you can think of at least several specific critical incidents that manifest the behaviors indicated.
Since each level builds on the previous proficiency levels of a competency, consistent mastery of the behaviors in the lower levels must be shown.

Write

It is recommended that you provide critical incidents on the third column of the answer sheet. Critical incidents are indicators that you possess the
competency and will confirm how the competency is manifested in real work situations. Please use the back of the page or attach additional sheets if
necessary. On the fourth column, please cite your strongest points for each competency or recommend training and/or developmental interventions if
reinforcements are needed.

Assistance

Assistance is available in Health Human Resource Development Bureau. You may call Ms. Tsarie Ulanday or Ms. Tsiki Obedoza at 651-7800 or at local
4250-51

DEPARTMENT OF HEALTH
HEALTH HUMAN RESOURCE DEVELOPMENT BUREAU

COMPETENCY PROFICIENCY ASSESSMENT HOSPITALS

FOR SALARY GRADE 1 9 (SKILLED)

SELF ASSESSMENT
Name
: ___________________________________
Position Title : ___________________________________
Status of Appointment: ____________________________
No. of years in current position: _____________________
CORE COMPETENCIES
Organizational Commitment
Integrity
Quality Service Focus
Teamwork
Stewardship of Resources
Self-Development
Attention to Communication
FUNCTIONAL COMPETENCIES
Applied Learning
Energy
Initiative
Interpersonal Relations
Safety Awareness
Expertise on: (area/field)
Time Management

LEVELS
C

Office/Service:
___________________________________
Division
:
___________________________________
No. of years in service:_________________________________
Date accomplished: ___________________________________
D

LEVELS
C

CRITICAL INCIDENTS

COMMENTS ON
STRENGTHS/DEVELOPMENTAL NEEDS

CRITICAL INCIDENTS

COMMENTS ON
STRENGTHS/DEVELOPMENTAL NEEDS

Validated by:
DOH-HHRBD, CompetencyProficiencyAssessment
Revision 1
28 November 2013

Name and Signature of Staff

Date:

Name, Position and Signature of Supervisor

Date:

DEPARTMENT OF HEALTH
HEALTH HUMAN RESOURCE DEVELOPMENT BUREAU

COMPETENCY PROFICIENCY ASSESSMENT HOSPITALS

FOR SALARY GRADE 1 9 (NON-SKILLED)

SELF ASSESSMENT
Name
: ___________________________________
Position Title : ___________________________________
Status of Appointment: ____________________________
No. of years in current position: _____________________
CORE COMPETENCIES
Organizational Commitment
Integrity
Quality Service Focus
Teamwork
Stewardship of Resources
Self-Development
Attention to Communication
FUNCTIONAL COMPETENCIES
Adaptability
Applied Learning
Initiative
Interpersonal Relations
Quality Orientation
Expertise on: (area/field)
Time Management

LEVELS
C

LEVELS
C

Office/Service:
___________________________________
Division
:
___________________________________
No. of years in service:_________________________________
Date accomplished: ___________________________________
D

CRITICAL INCIDENTS

COMMENTS ON
STRENGTHS/DEVELOPMENTAL NEEDS

CRITICAL INCIDENTS

COMMENTS ON
STRENGTHS/DEVELOPMENTAL NEEDS

Validated by:
DOH-HHRBD, CompetencyProficiencyAssessment
Revision 1
28 November 2013

Name and Signature of Staff

Date:

Name, Position and Signature of Supervisor

Date:

DEPARTMENT OF HEALTH
HEALTH HUMAN RESOURCE DEVELOPMENT BUREAU

COMPETENCY PROFICIENCY ASSESSMENT HOSPITALS

FOR SALARY GRADE 10 14

SELF ASSESSMENT
Name
: ___________________________________
Position Title : ___________________________________
Status of Appointment: ____________________________
No. of years in current position: _____________________
CORE COMPETENCIES
Organizational Commitment
Integrity
Quality Service Focus
Teamwork
Stewardship of Resources
Self-Development
Attention to Communication
FUNCTIONAL COMPETENCIES
Adaptability
Initiative
Interpersonal Relations
Networking
Results Orientation
Technical Expertise on: (area/field)
Time Management

LEVELS
C

LEVELS
C

Office/Service:
___________________________________
Division
:
___________________________________
No. of years in service:_________________________________
Date accomplished: ___________________________________
D

CRITICAL INCIDENTS

COMMENTS ON
STRENGTHS/DEVELOPMENTAL NEEDS

CRITICAL INCIDENTS

COMMENTS ON
STRENGTHS/DEVELOPMENTAL NEEDS

Validated by:
DOH-HHRBD, CompetencyProficiencyAssessment
Revision 1
28 November 2013

Name and Signature of Staff

Date:

Name, Position and Signature of Supervisor

Date:

DEPARTMENT OF HEALTH
HEALTH HUMAN RESOURCE DEVELOPMENT BUREAU

COMPETENCY PROFICIENCY ASSESSMENT HOSPITALS

FOR SALARY GRADE 15-17
SELF ASSESSMENT
Name
: ___________________________________
Position Title : ___________________________________
Status of Appointment: ____________________________
No. of years in current position: _____________________
CORE COMPETENCIES
Organizational Commitment
Integrity
Quality Service Focus
Teamwork
Stewardship of Resources
Self-Development
Attention to Communication
FUNCTIONAL COMPETENCIES
Adaptability
Analytical Thinking
Networking
Planning and Organizing
Program/Project Management
Results Orientation
Technical Consulting
Technical Expertise on; (area/field)

LEVELS
C

Office/Service:
___________________________________
Division
:
___________________________________
No. of years in service:_________________________________
Date accomplished: ___________________________________
D

LEVELS
C

CRITICAL INCIDENTS

COMMENTS ON
STRENGTHS/DEVELOPMENTAL NEEDS

CRITICAL INCIDENTS

COMMENTS ON
STRENGTHS/DEVELOPMENTAL NEEDS

Validated by:
DOH-HHRBD, CompetencyProficiencyAssessment
Revision 1
28 November 2013

Name and Signature of Staff

Date:

Name, Position and Signature of Supervisor

Date:

DEPARTMENT OF HEALTH
HEALTH HUMAN RESOURCE DEVELOPMENT BUREAU

COMPETENCY PROFICIENCY ASSESSMENT HOSPITALS

FOR SALARY GRADE 18-24
SELF ASSESSMENT
Name
: ___________________________________
Position Title : ___________________________________
Status of Appointment: ____________________________
No. of years in current position: _____________________
CORE COMPETENCIES
Organizational Commitment
Integrity
Quality Service Focus
Teamwork
Stewardship of Resources
Self-Development
Attention to Communication
FUNCTIONAL COMPETENCIES
Conceptual Thinking
Managing Performance
Planning and Organizing
Political Savvy
Problem Solving and Decision Making
Results Orientation
Technical Consulting
Technical Expertise on: (area/field)

LEVELS
C

LEVELS
C

Office/Service:
___________________________________
Division
:
___________________________________
No. of years in service:_________________________________
Date accomplished: ___________________________________
D

CRITICAL INCIDENTS

COMMENTS ON
STRENGTHS/DEVELOPMENTAL NEEDS

CRITICAL INCIDENTS

COMMENTS ON
STRENGTHS/DEVELOPMENTAL NEEDS

Validated by:
DOH-HHRBD, CompetencyProficiencyAssessment
Revision 1
28 November 2013

Name and Signature of Staff

Date:

Name, Position and Signature of Supervisor

Date:

DEPARTMENT OF HEALTH
HEALTH HUMAN RESOURCE DEVELOPMENT BUREAU

COMPETENCY PROFICIENCY ASSESSMENT HOSPITALS

FOR DIVISION CHIEFS

SELF ASSESSMENT

Name
: ___________________________________
Position Title : ___________________________________
Status of Appointment: ____________________________
No. of years in current position: _____________________
CORE COMPETENCIES
Organizational Commitment
Integrity
Quality Service Focus
Teamwork
Stewardship of Resources
Self-Development
Attention to Communication
FUNCTIONAL COMPETENCIES
Building a Successful Team
Managing Performance
Planning and Organizing
Problem Solving and Decision Making
Program/Project Management
Technical Consulting
Technical Expertise on: (area/field)
Visionary Leadership

LEVELS
C

Office/Service:
___________________________________
Division
:
___________________________________
No. of years in service:_________________________________
Date accomplished: ___________________________________
D

LEVELS
C

CRITICAL INCIDENTS

COMMENTS ON
STRENGTHS/DEVELOPMENTAL NEEDS

CRITICAL INCIDENTS

COMMENTS ON
STRENGTHS/DEVELOPMENTAL NEEDS

Validated by:
DOH-HHRBD, CompetencyProficiencyAssessment
Revision 1
28 November 2013

Name and Signature of Staff

Date:

Name, Position and Signature of Supervisor

Date:

DEPARTMENT OF HEALTH
HEALTH HUMAN RESOURCE DEVELOPMENT BUREAU

COMPETENCY PROFICIENCY ASSESSMENT HOSPITALS

FOR DIRECTORS

SELF ASSESSMENT

Name
: ___________________________________
Position Title : ___________________________________
Status of Appointment: ____________________________
No. of years in current position: _____________________
CORE COMPETENCIES
Organizational Commitment
Integrity
Quality Service Focus
Teamwork
Stewardship of Resources
Self-Development
Attention to Communication
FUNCTIONAL COMPETENCIES
Financial Management
Managing Change
Managing Conflict
Political Savvy
Problem Solving and Decision Making
Resource Management
Visionary Leadership

LEVELS
C

LEVELS
C

Office/Service:
___________________________________
Division
:
___________________________________
No. of years in service:_________________________________
Date accomplished: ___________________________________

CRITICAL INCIDENTS

COMMENTS ON
STRENGTHS/DEVELOPMENTAL NEEDS

CRITICAL INCIDENTS

COMMENTS ON
STRENGTHS/DEVELOPMENTAL NEEDS

Validated by:
DOH-HHRBD, CompetencyProficiencyAssessment
Revision 1
28 November 2013

Name and Signature of Staff

Date:

Name, Position and Signature of Supervisor

Date: