Republic of the Philippines

DEPARTMENT OF EDUCATION
Cordillera Administrative Region
Schools Division of Mountain Province
Bauko District 1
LAGAWA ELEMENTARY SCHOOL & COPUTAN PRIMARY SCHOOL

INDIVIDUAL PERFORMANCE COMMITMENT AND REVIEW FORM (IPCRF)

Name of Employee: DONABEL K. GAPACAN Name of Rater: MARTINA B. CODOD
Position : TEACHER 11 Position: MASTER TEACHER 1
Bureau/Division: DEPARTMENT OF EDUCATION -MOUNTAIN PROVINCE Date of Review:
Rating Period : JUNE 2016 – MARCH 2017

TO BE FILLED IN DURING PLANNING TO BE FILLED DURING EVALUATION

MFOs KRAs Objectives Performance Indicator
( Major Actual Result
(Quality, Efficiency, Timeliness)

Weight per KRA

Final
Time line
Output)

SCORE
Quality Efficiency Timeliness

RATING
Q E T

1. a. Prepares daily plans of activities 5 Plan was complete and 100% of Each step in the Learning 96-100% of lesson plans
including appropriate, adequate and the Ps were prepared with Experiences had a full objectives obtained and
Learning Process
BASIC EDUCATION SERVICES

updated instructional materials appropriate, adequate and description of what to do with updated all the lesson
updated Ims. an example with appropriate, plan for the day.
adequate and updated Ims.
March 2017
June 2016-

4 Plan was complete and 85-99% of Each step in the Learning 90-95% of lesson plans
40 %

10% the Ps were prepared with Experiences had a partial objectives obtained and
appropriate, adequate and description of what to do with updated all the lesson
updated Ims. an example with appropriate, plan for the day.
I. Teaching-

adequate and updated Ims.

3 Plan had one part missing and Each step in the Learning 85-89% of lesson plans
70-84% of the Ps were prepared Experiences had a partial objectives obtained and
with appropriate, adequate and description of what to do with updated all the lesson
1
 updated Ims.
2 Plan had one part missing and
55-69% of the Ps were prepared
with appropriate, adequate and
updated Ims.
1 Plan had two parts missing and
54% below of the Ps were
prepared with appropriate,
adequate and updated Ims.
1.b. Facilitates learning with the 5 Attained all the indicators
following indicators: 10%
 85% Developing average of all
the grades of pupils in the
Quarter 4 Attained 3 indicators
 100% promotion
 0 failure
 2 IPED Lesson Plans for
Language and Communication 3 Attained 2 indicators
in Kindergarten executed.
March 2017
June 2016-
2 Attained 1 indicator
1 Attained 0 indicator
2
an example with appropriate,
adequate and updated Ims.
No descriptions found in the
Learning Experiences of what
to do but with an example with
appropriate, adequate and
updated Ims.
No descriptions found in the
Learning Experiences of what
to do and example with
appropriate, adequate and
updated Ims.
Indicators have complete and
proper input of data.
3 out of 4 indicators have
complete and proper input of
data.
2 out of 4 indicators have
complete and proper input of
data.
1 out of 4 indicators have
complete and proper input of
data.
0 out of 4 indicators have
complete and proper input of
data.
plan for the day.
80-84% of lesson plans
objectives obtained and
updated all the lesson
plan for the day.
75-79% of lesson plans
objectives obtained and
updated all the lesson
plan for the day.
Accomplished the needed
forms to show the
completion of the indicators
within a given time.
Accomplished the needed
forms to show the
completion of the indicators
a day after the given time.
Accomplished the needed
forms to show the
completion of the indicators
2 days after the given time.
Accomplished the needed
forms to show the
completion of the indicators
3 days after the given time.
Accomplished the needed
forms to show the
completion of the indicators
1 week after the given time.
1.c. Integrates ICT to facilitate 10 Utilized 2 ICT at Utilized 2 ICT at
teaching learning process % Utilized 2 ICT at developmental developmental level per developmental level per
5 level per grading. grading clearly. grading clearly.
Utilized 1 ICT at Utilized 1 ICT at
Utilized 1 ICT at developmental developmental level per developmental level per

March 2017
June 2016-
4 level per grading. grading clearly. grading clearly.
3 Utilized 2 ICT at
Utilized 2 ICT at substitution level Utilized 2 ICT at substitution substitution level per
per grading. level per grading. grading.
2 Utilized 1 ICT at
Utilized 1 ICT at substitution level Utilized 1 ICT at substitution substitution level per
per grading. level per grading. grading.
1 No use of ICT Technology is not use. Technology is not use.
1.d.Visits parents of pupils needing 5% 5 100% of the parents of the 100% of the visits have Certificate of Appearance
academic monitoring/follow-up identified pupils were visited every Certificate of Appearance with with parent’s signature was
grading period. parent’s signature retrieved just after the visit.
4 85-99% of the parents of the 85-99% of the visits have Certificate of Appearance
identified pupils were visited every Certificate of Appearance with with parent’s signature was
grading period. parent’s signature retrieved 2 days after the
visit.
3 70-84% of the parents of the 70-84% of the visits have Certificate of Appearance
identified pupils were visited every Certificate of Appearance with with parent’s signature was
March 2017
June 2016-

grading period. parent’s signature retrieved 4 days after the

visit.
2 55-69% of the parents of the 55-69% of the visits have Certificate of Appearance
identified pupils were visited every Certificate of Appearance with with parent’s signature was
grading period. parent’s signature retrieved 1 week after the
visit.
1 54 and below% of the parents of 54% and below of the visits Certificate of Appearance
the identified pupils were visited have Certificate of with parent’s signature was
every grading period. Appearance with parent’s retrieved 2 weeks after the
signature visit.

3
1.e. Prepares contextualized 5% 5 1 Learning Resource quality
Learning Resources for IPED, Quality assured by the Division Office
assured
4 4 Contextualized
curriculum/developed learning
materials and/or instructional
materials
3 3 Contextualized
curriculum/developed learning
materials and/or instructional
March 2017
June 2016-
materials
2 2 Contextualized
curriculum/developed learning
materials and/or instructional
materials
1 1 Contextualized
curriculum/developed learning
materials and/or instructional
materials
KRA 1
4
1 Learning Resource quality
assured by the Division Office
reproduced and utilized by the
school.
4 Contextualized
curriculum/developed learning
materials and/or instructional
materials reproduced and
utilized by the school.
3 Contextualized
curriculum/developed learning
materials and/or instructional
materials reproduced and
utilized by the school.
2 Contextualized
curriculum/developed learning
materials and/or instructional
materials reproduced and
utilized by the school.
1 Contextualized
curriculum/developed learning
materials and/or instructional
materials reproduced and
utilized by the school.
Learning Resources
submitted for quality
assurance acted upon in 1
month or less
4 Contextualized
curriculum/developed
learning materials and/or
instructional materials
reproduced and utilized by
the school.
3 Contextualized
curriculum/developed
learning materials and/or
instructional materials
reproduced and utilized by
the school.
2 Contextualized
curriculum/developed
learning materials and/or
instructional materials
reproduced and utilized by
the school.
1 Contextualized
curriculum/developed
learning materials and/or
instructional materials
reproduced and utilized by
the school.
 2. a. Maintains 0% drop-out rate in 5 Has complete evidences, as Evidences have complete and Accomplished the needed
Kindergarten through the following: follows: proper input of data. documents/evidences
 Awarding of citations every end 5%  Awarding of citations every within the given time.
of the quarter end of the quarter
 Immediate feedback to parents if  Immediate feedback to
a pupil is absent parents if a pupil is absent
 Seek assistance from the PTA  Seek assistance from the
officers PTA officers
4 Has 2 evidences out of 3 2 out of 3 evidences have Accomplished the needed

March 2017
June 2016-
complete and proper input of documents/ evidences 2
data. days after the given time.
2. Classroom Management/Environment

3 Has 1 evidences out of 3 1 out of 3 evidences have Accomplished the needed

complete and proper input of
data.
2 Has 0 evidences out of 3 0 out of 3 evidences have
complete and proper input of
data.
25%
documents/ evidences 4
days after the given time.
Accomplished the needed
documents/ evidences 5
days after the given time.

1 Did not conduct any of the Did not conduct any of the Accomplished the needed
30%

indicators. indicators. documents/ evidences 10

2.b. Implements Child Protection as 5 Has complete evidences as
shown by the following evidences: follows:
 Organizing and Child Protection  Organizing and
Committee 10% Protection Committee
June 2016, to March 2017
days after the given time.
Evidences have completed Accomplished evidences
and proper input of data. within a given time.
Child

 Display of the Child Protection  Display of the Child

Committee Members Protection Committee
 Making of anti-bullying policies Members
 Formulating and display of code  Making of anti-bullying
of conduct policies
 Accomplishing reports on report  Formulating and display of
of incidents of bullying and child code of conduct
abuse.  Accomplishing reports on
report of incidents of bullying
and child abuse.

5
 4 Has 4 evidences out of 5
3 Has 3 evidences out of 5
2 Has 2 evidences out of 5
1 Has 1 evidences out of 5
2. c. Monitors attendance of the 10% 5 100% of the pupils’ daily
pupils regularly attendance is recorded properly
evident in the daily total
attendance in SF 2.
4 85-99% of the pupils’ daily
attendance is recorded properly
evident in the daily total
attendance in SF 2.
3 70-84% of the pupils’ daily
March 2017
June 2016-
attendance is recorded properly
evident in the daily total
attendance in SF 2.
2 55-69% of the pupils’ daily
attendance is recorded properly
evident in the daily total
attendance in SF 2.
1 54% and below of the pupils’ daily
attendance is recorded properly
evident in the daily total
attendance in SF 2.
2.d. Maintains a conducive 5% 5 Attained all the following
March
2016-
June
child-friendly classroom atmosphere indicators:
and school environment through the  Presence of Classroom Rules
6
4 out of 5 evidences have Accomplished evidences a
complete and proper input of day after the given time.
data.
3 out of 5 evidences have Accomplished evidences 2
complete and proper input of days after the given time.
data.
2 out of 5 evidences have Accomplished evidences 4
complete and proper input of days after the given time.
data.
1 out of 5 evidences have Accomplished evidences 5
complete and proper input of days after the given time.
data.
Established a less time Every day
consuming, routinary and
effective technique of checking
the attendance.
Established a routinary and 4 times a week
effective technique of checking
the attendance.
Utilized the traditional routinary 3 times a week
checking of the attendance
Established no technique of 2 times a week
checking the attendance.
Missed to check attendance Once a week
once I a while.
Always maintained a Supervised the
conducive child-friendly maintenance of conducive
classroom atmosphere and child-friendly classroom
following indicators:  Well-structured well kept, school environment through atmosphere and school
 Presence of Classroom Rules orderly, and well ventilated the 5 indicators. environment through the 5
 Well-structured well kept, classroom indicators at all times.
orderly, and well ventilated  Presence of bins for waste
classroom segregation
 Presence of bins for waste  Presence of appropriate
segregation adage/pictures
 Presence of appropriate  Observation and
adage/pictures implementation of Disaster
 Organization and Risk Reduction Management.
implementation of Disaster Risk 4 Attained 4 out of the 5 indicators Frequently maintained a Supervised the maintenance
Reduction Management. conducive child-friendly of conducive child-friendly
classroom atmosphere and classroom atmosphere and
school environment through the 5 school environment through
indicators. the 5 indicators most of the
times.
3 Attained 3 out of the 5 indicators Sometimes maintained a Supervised the maintenance
conducive child-friendly of conducive child-friendly
classroom atmosphere and classroom atmosphere and
school environment through the 5 school environment through
indicators. the 5 indicators sometimes.
2 Attained 2 out of the 5 indicators Rarely maintained a conducive Supervised the maintenance
child-friendly classroom of conducive child-friendly
atmosphere and school classroom atmosphere and
environment through the 5 school environment through
indicators. the 5 indicators without
documentation.
1 Attained 1 out of the 5 indicator Never maintained a conducive No time to supervise.
child-friendly classroom
atmosphere and school
environment through the 5
indicators.

KRA 2

7
 3.a. Participates in professional 5 100% of the IPDP weaknesses
development to address IPDP. are to be addressed.
5% 4 85-99% of the IPDP weaknesses
are to be addressed.
March 2017
June 2 016-
3 70-84% of the IPDP weaknesses
are to be addressed.
2 55-69% of the IPDP weaknesses
are to be addressed.
1 54% of the IPDP weaknesses are
3. Professional Development
to be addressed.
3.b. Attends/ participates in any 5 Attended/ participated at least 5 or
training/seminar/activities/conferences
more training/seminars/activities/
15%
/festivals called for. conferences/festivals called for.
Required Evidences: 5%
a.Certificate of Appearance/Participation 4 Attended/ participated at least 4
b.Memorandum training/seminars/activities/
c.Authority to travel Conferences/festivals called for.
d.Pictures/Official Documentation 3 Attended/ participated at least 3
e.Narrative Report
training/seminars/activities/
March 2017
June 2016-
Conferences/festivals called for.
2 Attended/ participated at least 2
training/seminars/activities/
Conferences/festivals called for.
1 Attended/ participated only
training/seminars/activities/
Conferences/festivals called for.
8
100% of the IPDP weaknesses
are to be addressed faithfully.
85-99% of the IPDP
weaknesses are to be
addressed faithfully.
70-84% of the IPDP
weaknesses are to be
addressed faithfully.
55-69% of the IPDP
weaknesses are to be
addressed faithfully.
54% of the IPDP weaknesses
are to be addressed faithfully.
Attended/ participated at least 5
or more
training/seminars/activities/
Conferences/festivals called for.
Attended/ participated at least 4
trainings/seminars/activities/
Conferences/festivals called for.
Attended/ participated at least 3
trainings/seminars/activities/
Conferences/festivals called for.
Attended/ participated at least 2
training/seminar/activity/
Conferences/festivals called for.
1 Attended/ participated only 1
training/seminars/activities/
Conferences/festivals called for.
100% of the IPDP
weaknesses are to be
addressed faithfully.
85-99% of the IPDP
weaknesses are to be
addressed faithfully.
70-84% of the IPDP
weaknesses are to be
addressed faithfully.
55-69% of the IPDP
weaknesses are to be
addressed faithfully.
54% of the IPDP
weaknesses are to be
addressed faithfully.
Evidences was
accomplished/assorted
immediately.
Evidences was
accomplished/assorted 1
month after.
Evidences was
accomplished/assorted 2
months after.
Evidences was
accomplished/assorted 6
months after.
No evidences.
 3.c. Demonstrates positive attitude
and professional ethics through the
following:
 Punctuality
 100% school attendance
 Desirable and professional and
personal behaviors
 Harmonious relations
superiors, colleagues,
subordinates, learners, parents
and stakeholders
 Good reputation with respect to
financial matters such as the
settlement of debts/loans and
other financial affairs
4.a.Conducts
periodic/regular/GPTA/HRPTA
meetings/ conferences
4. Community Involvement
10%
20%
5 Attained all 5 indicators Always demonstrate the five Always demonstrate the
indicators. five indicators.
4 Attained 4 of the 5 indicators Frequently demonstrate the Frequently demonstrate
5% five indicators. the five indicators.
3 Attained 3 out of the 5 indicators Sometimes demonstrate the Sometimes demonstrate
five indicators. the five indicators.
June 2016-
March 2017
2 Attained 2 out of the 5 indicators Rarely demonstrate the five Rarely demonstrate the
with indicators. five indicators.
1 Attained 1 of the 5 indicators Never demonstrate the five Never demonstrate the
indicators. five indicators.
KRA 3
5% 5 Conduct 5 Minutes of meetings are done
periodic/regular/GPTA/HRPTA 5 meetings completely a day after the meeting.
meetings/ conferences within the documented
school year.
4 Conduct 4 Minutes of meetings are done
periodic/regular/GPTA/HRPTA 4 meetings completely 2-3 days after the meeting.
meetings/ conferences within the documented
school year.
March 2017
3 Conduct 3 Minutes of meetings are done
June 2016-
periodic/regular/GPTA/HRPTA 3 meetings completely 4 days after the meeting
meetings/ conferences within the documented
school year.
2 Conduct 2 Minutes of meetings are done
periodic/regular/GPTA/HRPTA 2 meetings completely 5 days after the meeting
meetings/ conferences within the documented
school year.
1 Conduct 1 Minutes of meetings are done
periodic/regular/GPTA/HRPTA at the end of the school year
1 meeting completely documented
meetings/ conferences within the
school year.
9
 4.b. Participates in community/joint 5% 5 Has complete evidences Evidences have complete and Accomplished the needed
school-community activities during proper input of data. documents/evidences within
the school year. the given time.
 Clean up drive 4 Has 4 evidences 4 out of 6 evidences have Accomplished the needed
 Nutrition Month complete and proper input of documents/ evidences 2
data. days after the given time.
 Buwan ng Wika

March 2017
June 2016-
 Crime Prevention Program 3 Has 3 evidences 3 out of 6 evidences have Accomplished the needed
complete and proper input of documents/ evidences 4
 Begnas di Bauko data. days after the given time.
 Joint Christmas Program 2 Has 2 evidences 2 out of 6 evidences have Accomplished the needed
complete and proper input of documents/ evidences 5
data. days after the given time.
1 Has 1 evidence 1 out of 6 evidences have Accomplished the needed
complete and proper input of documents/ evidences 10
data. days after the given time.
KRA 4
5. a.Initiates Feeding Program 5% 5 Presence of all the five evidences Completed 120 days of feeding Completed 120 days of
Required Evidences: feeding
June 2016 – March 2017
a. Feeding Log Sheet 4 Presence of all the four evidences Completed 110 days of feeding Completed 110 days of
b. Pictures feeding
3 Presence of all the three evidences Completed 100 days of feeding Completed 100 days of
5. Others

c. Nutritional Status of pupils

(5%)

feeding
d. Year end Accomplishment Report
2 Presence of two evidences Completed 90 days of feeding Completed 90 days of
e. Designation
feeding
1 Presence of 1 evidences Completed 80 and below days of Completed 80 and below
feeding days of feeding

KRA 5

OVER ALL RATING FOR ACCOMPLISHMENT

Rater: MARTINA B. CODOD Ratee: DONABEL K. GAPACAN Approving Authority: JUANA D. DALANG
Master Teacher 1 Teacher 11 Principal 1

10
 Adjectival Rating Scale
4.500 - 5.000 - Outstanding
3.500 - 4.499 - Very Satisfactory
2.500 - 3.499 - Satisfactory
1.500 - 2.499 - Unsatisfactory
1.000 - 1.499 - Poor

PART III: SUMMARY OF RATINGS FOR DISCUSSION

Final Performance Result Rating Adjectival Rating

4.2 VERY SATISFACTORY

Accomplishment of KRA’s and Objectives

RATER- RATEE AGREEMENT

The signatures below confirm that the employee and his/her superior have agreed to the content of this appraisal form and the performance rating.
Name of Employee Name of Superior
DONABEL K. GAPACAN MARTINA B. CODOD

Signature Signature

Date Date
APRIL 13, 2017

11
 PART IV: DEVELOPMENT PLANS
Strengths Developmental Needs Action Plan Timeline Resources Needed

12
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