IFUGAO STATE UNIVERSITY

Nayon, Lamut, Ifugao

PERFORMANCE EVALUATION REPORT FORM
From June2010-October 2010

OFFICE: Main Campus

DIVISION/SECTION: College of Health Sciences

Employee: JOEFREY D. GAERLAN

Position: Clinical Instructor

Part I: Performance (70%)

Duties and responsibilities PERFORMANCE TARGET RATING

TARGET QUANTITY QUALITY TIME QN QI TIME
Planned Actual Planned Actual Planned Actual
I. INSTRUCTION
1. Prepares course outline, Syllabus covers prescribed topics in Syllabus covers prescribed 90 % 100 % Submit before the Submitted before the 6 8 10
syllabus, instructional (NCM 104) Inflammatory and topics in Inflammatory and effective effective deadline ( 2 days after deadline ( 2 days after
material and clinical Immunology, Cellular Aberration in Immunology, Cellular the start of classes) the start of classes)
teaching plan (CTP) Nursing; prepares 1 Course Outline, 1 Aberration in Nursing;
Instructional Material and 1Clinical prepares course outline,
Teaching Plan(Operating Room) instructional material and
clinical teaching
plan(Operating Room)
2. Teach NCM 104 Render 4-hour lecture per week Render 4-hour lecture per 90 % 95 % Finish topics before the Finished topics before 8 8 6
Inflammatory and week effective effective scheduled final the scheduled final
Immunology, Cellular examinations examinations
Aberration in Nursing
3. Design and use 2 drawings/illustrations 2 drawings/illustrations 90 % 95 % Use as Used as 8 8 6
instructional materials 5x Computer Aided Instruction 5x Computer Aided effective effective needed/scheduled needed/scheduled
Instruction
4. Facilitate group activities role play, case analysis/ situation role play, case analysis/ 93 % 95 % Facilitate activities as Facilitated activities as 8 8 6
such as case analysis or analysis, group discussions, situation analysis, group effective effective scheduled scheduled
situation analysis and group discussions,
discussion
5. Check attendance of Twice per lecture/ RLE day Twice per lecture/ RLE day 97 % 100 % 15 minutes after the 1st 15 minutes after the 1st 8 8 6
students during lecture and effective effective hour and 15 minutes hour and 15 minutes
RLE duties before the lecture or before the lecture or
duty ends duty ends
6. Supervise students in
their RLE duties in the
Operating Room
7. Conduct ward class
8. Prepare and submit test
questions
9. Evaluate students’
performance
10. Submit reports and
grading sheets
II. DESIGNATION
1. Designated as adviser of
BSN IV
III. OTHER
ASSIGNMENTS
1. Attend faculty meeting
and seminars/trainings
2. Participate in school
activities
Assist 3 groups of BSN IV Assist 3 groups of BSN IV 95 % 100 % b. 8-4, ThFS b. 8-4, ThFS 10 8 8
students students effective effective
1 ward class/ group 1 ward class/ group 85 % 100 % Spend 4 hours of the 1st Spent 4 hours of the 1st 8 8 6
effective effective day of duty per rotation day of duty per rotation
100-point examination composed of 100-point examination 90 % 100 % Submit questionnaire Submitted questionnaire 6 8 10
multiple choice, identification, composed of multiple choice, effective effective for encoding and for encoding and
matching type, true or false and essay identification, matching type, reproduction 1 week reproduction 1 week
questions true or false and essay before schedule of before schedule of major
questions major exams exams
Lecture:2 major examinations,8 Lecture:2 major 90 % 98 % Conduct evaluation Conducted evaluation 10 8 10
quizzes examinations,8 quizzes effective effective measures as scheduled measures as scheduled
Recitations/class participation Recitations/class participation and needed and needed
RLE: Actual observation, 2 major RLE: Actual observation, 2
exams, 1 evaluation exam and 2 major exams, 1 evaluation
quizzes/rotation, 1 case exam and 2 quizzes/rotation,
presentation/group , NCP/student, 1 1 case presentation/group ,
journal article NCP/student, 1 journal
article
Submit dully accomplished PES, Submitted dully 95 % 100 % Submit DTR within 1 Submitted DTR within 1 6 8 10
DTR and 10 grading sheets (2 lecture, accomplished PES, DTR effective effective week after the last day week after the last day
5 RLE) and11 grading sheets (2 of the month, PES as of the month, PES as
lecture, 9 RLE) scheduled, lecture scheduled, lecture
grading sheets 1 week grading sheets 1 week
after major exam and after major exam and
RLE grading sheets 2 RLE grading sheets 2
days after each rotation days after each rotation
Supervise the class and conduct 3 Supervised the class and Schedule meetings for Schedule meetings for 8 8 10
meetings; set consultation hours ( 10 conduct 3 meetings; set 90% 100 % planning 1 week before planning 1 week before
hours a week or as needed) consultation hours ( 10 hours effective effective college and institute college and institute
a week or as needed) activities commence; activities commence;
sets 10:00am- 12:00nn sets 10:00am- 12:00nn
every Mondays and every Mondays and
Tuesdays as Tuesdays as consultation
consultation hours hours
6 8 8
All faculty meetings and 2 seminars Attended all faculty meetings 85 % 100 % As scheduled As scheduled
and 2 seminars effective effective
Intramurals, College Day, Tree Intramurals, College Day, 90 % 100 % As scheduled As scheduled 6 8 8
Planting, Capping and Pinning Tree Planting, Capping and effective effective
Ceremonies, Nutrition Month, Pinning Ceremonies,
 Accreditation Nutrition Month,
Accreditation
TOTAL: 98 104 104
GRAND TOTAL: 306
AVERAGE: 7.84
EQUIVALENT POINT SCORE: 5.488
I agree to achieve these targets for the rating period from June 2010 to October 2010 I agree to assist the employee to achieve his target for the said period

JOEFREY D. GAERLAN, RN, RM MAN NANCY ANN P. GONZALES, RN, MAN, Ph.D.
Instructor Name and Signature of Rater

PART II. BEHAVIORAL DIMENSION (30%)

1. Courtesy ……………………..10
2. Human Behavior…………….. 8
3. Punctuality ………………….. 8
4. Initiative ……………………. 10

TOTAL: 36
Average Point Score: 9
Equivalent Point Score: 2.7
Overall Point Score: 8.18
Equivalent Adjectival Rating: Very Satisfactory

EMPLOYEE COMMENT/REPORTS DISCUSSED RATING WITH:

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REPORT RATER’S COMMENTS/ REMARKS DISCUSSED RATING WITH:

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Signature of Rater’s Supervisor Date