COM-SPMS FORM NO.

3 ( IPCR)
CITY OF MANILA -STRATEGIC PERFORMANCE MANAGEMENT SYSTEM (COM-SPMS) TEMPLATE

INDIVIDUAL PERFORMANCE COMMITMENT AND REVIEW IPCR)

I, _________________________________________ (Name,) STAFF NURSE ( NURSE I, II , III ) (Position/Designation), NURSING SERVICE , (Division)
_______________________________________________( Department), commit to deliver and agree to be rated on the attainment of the following targets in accordance with the indicated
measures for the period ______________________________to ___________________________, 20____.

Signature
Date of Signing (Beginning of the Rating Period):
________________________
REVIEWED BY APPROVED BY:

Immediate Supervisor Department Head

Date Date
RATING SCALE LEGEND
5 - Outstanding Q- Quality
4- Very Satisfactory E- Efficiency
3 - Satisfactory T-Timeliness
2 -Unsatisfactory A- Average
1- Poor

RATING
Major Final Output( MFO) Success Indicators
Actual Accomplishments REMARKS
( please add rows if necessary) (Targets + Measures) Q E T A

MFO 1.
Basic and Specialized Medical Services  100% of patients within:
 Patient Care Management For minimal to moderately ill: 15 to 30 minutes
For critically ill: 1 to 2 hours
 100% of patients given quality nursing care within
the shift
 100% of patient’s health condition and nursing
care
documented within the shift
  100% of patient’s referral coordinated within the
shift
 100% health teachings to patients provided within
the shift

MFO 2.
Regulatory Services for Health Products,
Devices, Equipment and Facilities
 100% of medical equipment and facilities handled
and maintained daily
 100% of medicines administered to patients with
prescription and recorded to patient’s chart per
shift
 100% of medicines and supplies used to patients
reflected in the availment form per shift
 conducted daily inventory of medicines, supplies
and equipment.

MFO 3.
General Administrative Support Services
(GASS)
 Record Management  100% completeness of patient’s chart ensured per
shift
 Admitting & Discharge  100% of admitted and discharged patients
properly
 Dietary Services recorded in the logbooks per shift
 100% of patient’s diet list submitted daily
 100% of newly admitted patient’s diet and changes
 Philhealth Services in patient’s diet informed per shift
 100% of patient’s classification facilitated per shift
 Housekeepig
 100% of clinical area cleaned and maintained per
shift
 Conduct concurrent and terminal disinfection per
shift
MFO 4.  100% of assistance provide to departments
Support to Operations under the City Government of Manila and other
agencies
 Health Activities of the City
 Socio-cultural Activities
 Disaster management
  Medical Mission
 Working Committees of the Hospital
Management

FINAL AVERAGE RATING

ADJECTIVAL RATING

DISCUSSED WITH : ASSESSED BY : FINAL RATING BY:

Immediate Supervisor Department Head
I certify that I discussed my assessment of the performance with the
employee .

Name & Signature of Ratee Name & Signature of Rater Name & Signature of Department Head
Position : Position : Position :
Date : Date : Date :