INDIVIDUAL PERFORMANCE COMMITMENT AND REVIEW FORM

Name of Employee: Name of Rater:

Position: Teacher I Position: HEAD TEACHER III
Division: Date of Review:
Rating Period: April 2016 to March 2017
TO BE FILLED IN DURING PLANNING TO BE FILLED IN DURING EVALUATION

Weighted Performance Indicators Actual Results Rating

MFOs KRAs Objectives Timeline per KRA Score
Quality Efficiency Timeliness Quality Efficiency Timeliness Q E T Ave.
7-Apr-17 1-Apr-17

Prepared 135 instructional

1. Prepared instructional plans
and daily logs of activities
including appropriate, adequate
and updated instructional
materials.
Prepared 175 lesson plans 175 lesson plans
April plans and daily logs of 135 lesson plans prepared
prepared of activities prepared of activities
2016- activities including including appropriate,
March 10% appropriate, adequate and adequate and updated including appropriate, including appropriate, 4 4 4 4 0.400
adequate and updated adequate and updated
2017 updated instructional instructional materials
instructional materials instructional
materials.

7-Apr-17 1-Apr-17

95% learning facilitated

2. Facilitated learning in
elementary schools through
functional lesson plans, daily
logs and innovative teaching
strategies.
Facilitated 75% learning in 75% learning facilitated in Facilitated 95% learning in
April in elementary schools
elementary schools through elementary schools through elementary schools through
2016- through functional lesson
March 10% functional lesson plans, daily functional lesson plans, daily functional lesson plans, daily
plans, daily logs and
4 4 4 4 0.400
2017 logs and innovative teaching logs and innovative teaching logs and innovative teaching
innovative teaching
strategies. strategies. strategies.
strategies.

7-Apr-17 1-Apr-17
1. Teaching 4 Initiated discipline of
Learning 3. Initiated discipline of students April Initiated 2 discipline of 2 initiated discipline of students Initiated 4 discipline of
students including
Process(40%) including classroom rules, 2016- students including classroom including classroom rules, students including classroom
March 10% classroom rules, guidelines 5 4 4 4.333333 0.433
guidelines and individual and rules, guidelines and guidelines and individual and rules, guidelines and individual
2017 and individual and group
group tasks. individual and group tasks. group tasks. and group tasks.
tasks.

Page 1 of 6
 INDIVIDUAL PERFORMANCE COMMITMENT AND REVIEW FORM

Name of Employee: Name of Rater:

Position: Teacher I Position: HEAD TEACHER III
1. Teaching
Division:
Learning Date of Review:
Process(40%) April 2016 to March 2017
Rating Period:
TO BE FILLED IN DURING PLANNING TO BE FILLED IN DURING EVALUATION

Weighted Performance Indicators Actual Results Rating

MFOs KRAs Objectives
4. Monitored attendance,
diversity appreciation, safe,
positive and motivating
environment overall physical
atmosphere, cleanliness and and
orderliness of classrooms
including proper waste disposal.
Timeline per KRA Score
Quality Efficiency Timeliness Quality Efficiency Timeliness Q E T Ave.
Monitored 4 indicators 4 indicators monitored 7-Apr-17 Monitored 5 indicators 5 indicators monitored 27-Mar-17
attendance, diversity attendance, diversity attendance, diversity attendance, diversity
appreciation, safe, positive appreciation, safe, positive and appreciation, safe, positive and appreciation, safe, positive
and motivating environment motivating environment overall motivating environment overall and motivating environment
overall physical atmosphere, physical atmosphere, cleanliness physical atmosphere, overall physical
cleanliness and and and and orderliness of cleanliness and and atmosphere, cleanliness
April orderliness of classrooms classrooms including proper orderliness of classrooms and and orderliness of
2016- including proper waste waste disposal. including proper waste classrooms including proper
March 10% disposal. disposal. waste disposal. 5 5 5 5 0.500
2017

Quaterly Quarterly
1. Monitored, evaluated and April Monitored, evaluated and 75% pupils/students progress Monitored, evaluated and 85% pupils/students
2016-
maintained pupils/students' March 5% maintained 75% were monitored, evaluated and maintained 85% progress were monitored, 4 4 4 4 0.200
progress. 2017 pupils/students' progress. maintained. pupils/students' progress. evaluated and maintained.

Quarterly Quarterly

2. Conducted April Conducted 4 Conducted 6 6 remediation/ enrichment

4 remediation/enrichment
remediation/enrichment 2016- remediation/enrichment remediation/enrichment programs conducted to
March 5% programs conducted to improve 4 5 4 4.333333 0.217
2.Pupils/ programs to improve programs to improve programs to improve improve performance
Students 2017 performance indicators.
performance indicators. performance indicators. performance indicators. indicators.
outcome
(20%)
3. Maintained updated Maintained 75% updated 75% maintained updated Quarterly Maintained 95% updated 95% maintained updated Quarterly
April
pupils/students' school records 2016- pupils/students' school pupils/students' school records pupils/students' school records pupils/students' school
March 5% records records 4 4 4 4 0.200
2017

4. Attained the required GSA for Yearly Yearly

April
grade level and learning areas 2016- Attained 75% of the 75% attained of the required Attained 95% of the 95% attained of the
March 5% required GSA GSA required GSA required GSA 4 4 4 4 0.200
2017

Page 2 of 6
 INDIVIDUAL PERFORMANCE COMMITMENT AND REVIEW FORM

Name of Employee: Name of Rater:

Position: Teacher I Position: HEAD TEACHER III
Division: Date of Review:
Rating Period: April 2016 to March 2017
TO BE FILLED IN DURING PLANNING TO BE FILLED IN DURING EVALUATION

Weighted Performance Indicators Actual Results Rating

MFOs KRAs Objectives Timeline per KRA Score
Quality Efficiency Timeliness Quality Efficiency Timeliness Q E T Ave.
Quarterly Quarterly
April Conducted 4 regular/
2016- 4 regualr/periodic PTA 5 regualr/periodic PTA
1. Conducted regular/ periodic meetings/conferences Conducted 5 regular/ periodic meetings/ conferences
March 10% periodic PTA meetings/ 4 4 4 4 0.400
PTA meetings/ conferences conducted PTA meetings/ conferences conducted
2017 conferences

December December
April 5 parents of students
2. Visited parents of students Visited 2 parents of students 2 parents of students needing Visited 5 parents of students
2016- needing academic
needing academic monitoring/ March 10% needing academic monitoring/ academic monitoring/ follow - up needing academic monitoring/
monitoring/ follow - up
3 5 3 3.666667 0.367
follow - up 2017 follow - up visited follow - up
3. Community visited
Involvement
(30%) April 2016- April-March
March 2017

3. Undertaken/initiated
projects/events/activities with
external funding/sponsorship
within the target date
April Undertaken/ initiated 1 1 projects/ events/ activities Undertaken/ initiated 2 2 project/ events/activities
2016- projects/events /activities with initiated with external funding/ projects/events/activities with initiated with external
March 10% external funding/ sponsorship sponsorship within the target external funding/sponsorship funding/sponsorship within
3 4 3 3.333333 0.333
2017 within the target date date within the target date the target date

April Yearly none none Yearly

2016-
1. Conducted Action Research March 1% none none 1 1 1 1 0.010
2017
April April 2016- April- March
4. 2.Participated in activities such 2016- Participated 1 activitiy such 1 activitiy participated such as March 2017 Participated 1 activitiy such as 1 activitiy participated such
March 5% 3 3 3 3 0.150
Professional as teachers' association as teachers' association teachers' association teachers' association as teachers' association
Growth and 2017
Development June 2016- June 2016-
April March 2017 March 2017
3. Produced publications/
2016-
creative work for school March 2% none none none none 1 1 1 1 0.020
paper/division publications 2017

June 2016- June 2016-

March 2017 4 special March 2017
4. Received special April Received 1 special 1 special Received 4 special
2016- awards/citattion/recognition
awards/citattion/recognition for March 2% awards/citattion/recognition awards/citattion/recognition for awards/citattion/recognition for 4 4 4 4 0.080
for exemplary performance
exemplary performance 2017 for exemplary performance exemplary performance received exemplary performance
received

Page 3 of 6
 INDIVIDUAL PERFORMANCE COMMITMENT AND REVIEW FORM

Name of Employee: Name of Rater:

Position: Teacher I Position: HEAD TEACHER III
Division: Date of Review:
Rating Period: April 2016 to March 2017
TO BE FILLED IN DURING PLANNING TO BE FILLED IN DURING EVALUATION

Weighted Performance Indicators Actual Results Rating

MFOs KRAs Objectives Timeline per KRA Score
Quality Efficiency Timeliness Quality Efficiency Timeliness Q E T Ave.

KRA 1 4.50 4.25 4.25 4.33 1.733

KRA 2 4 4.25 4 4.083 0.816
KRA 3 3.333 4.333 3.333 3.666 1.099
KRA 4 2.25 2.25 2.25 2.25 0.225

Rating for Accomplishment 3.873

Rater Ratee Approving Authority

Page 4 of 6
Page 5 of 6
 SUMMARY OF RATINGS FOR DISCUSSION

FINAL PERFORMANCE RATING

ACCOMPLISHMENTS OF KRA'S AND OBJECTIVES 3.87
VS
Employee- Supervisor Agrreement

The signatures below confirm that the employee and his /her superior have agreed to the contents of the performance as captured in this form.

Name of Employee: DOREEN A. CALUMPANG Name of Superior: MERLYN S. ROSALES

Signature: Signature:
Date: MARCH, 2017 Date:

DEVELOPMENT PLANS

STRENGTHS
DEVELOPMENTACTION PLAN RECOMMENDED TIMELINE RESOURCES NEEDED
NEEDS DEVELOPMENTAL INTERVENTION

1. Watch service improvement

Professionalism Service
and Ethics Orientation program, practice public speaking June 2016 - March 2017 Media, magazines, books and entertainment shows
and watch open forum

DOREEN A.CALUMPANG MERLYN S. ROSALES LELANIE T. CABRERA,CESE

Ratee Rater Assistant Schools Division Superintendent