DOH - SPMS Form 3

INDIVIDUAL PERFORMANCE COMMITMENT AND REVIEW (IPCR)

I,____________, of the _CAGAYAN VALLEY MEDICAL CENTER_, commit to deliver and agree to be rated on the attainment of the following targets in accordance with the indicated
measures for the period _JANUARY_ to _JUNE_, _2016_

Name of Emp. Date:

Approved By: Date

Name of Supervisor

5 – Outstanding
4 – Very Satisfactory
3 – Satisfactory
2 - Unsatisfactory
RATING SCALE 1 - Poor

RATING
Success indicator
Output
(Target + Measure)
Actual Accomplishment Q E T A Remarks
(1) (2) (3) (4)

All patients/cadavers are safely transported

CORE
within 5 minutes upon notice

All oxygen are properly and accurately

Better Health Outcomes CORE
installed within 1-2 minutes upon notice

Maintains cleanliness, orderliness and

performs disinfection on all area of CORE
assignment throughout the shift

All general assemblies, unit meetings,

Human Resource Training & seminars, trainings and other hospital
CORE
Development Services activities were attended with no tardiness
recorded
RATING
Total Overall Rating
Final Average Rating
Adjectival Rating
Comments and Recommendation for Development Purposes
 RATING
Success indicator
Output
(Target + Measure)
Actual Accomplishment Q E T A Remarks
(1) (2) (3) (4)
Discussed With: Assessed by: Date Final Rating by: Date
I certify that I discussed my assessment of the perfomance with the
employee

Employee Supervisor Next Higher Supervisor

Legend: 1- Quality 2 -Efficiency 3 - Timeliness 4 - Average