DOH SPMS Form 3

INDIVIDUAL PERFORMANCE COMMITMENT AND REVIEW (IPCRF)

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, 2017.

Name of Employee: ARNELYN Z. ASUNCION Date: July 14, 2017

Approved by: Date

Name of Supervisor

5 Outstanding
4 Very Satisfactory
3 Satisfactory
2 Unsatisfactory
1 Poor

RATING REMARKS
OUTPUT SUCCESS INDICATOR Q E T A
ACTUAL ACCOMPLISHEMENT
(TARGET + MEASURE) (1) (2) (3) (4)
100% excellently preforms assigned procedure 90%-99% of assigned patients were 4 3 5 3.7 CORE
within the specified time. accorded with quality nursing care
100% comprehensively assists in the promotion 90%-99% of assisted patients were 3 4 5 4 CORE
of health education to patients and their family accorded with quality nursing care
Ensures effective and efficient response to all 90%-99% of assisted patients were 4 4 4 4 CORE
patients concerns and needs within the specified accorded with quality nursing care
time
95% of medical/surgical supplies and equipment 85%-89% medical/surgical supplies 4 4 3 3.6 CORE
for every procedure are efficiently and effectively and equipment were prepared
prepared within the specified time
Better Health All ancillary requests, prescription and patients All ancillary requests, prescriptions 5 5 5 5 CORE
Outcome medical records are forwarded to designated and patients medical records were
sections immediately upon availability of the forwarded to designated sections
needed document/specimen
100% satisfactorily assists in maintaining 90%-90% of request/defects were 4 4 4 4 CORE
inventory of supplies, functionality of equipment addressed
and facilities regularly
 All patients/cadavers are safely transported All patients were transported safely 5 5 5 5 CORE
within 5 minutes upon notice
All oxygen were properly and accurately installed All oxygen needed were installed 5 5 5 5 CORE
within 1-2 minutes upon notice
Maintains cleanliness and orderliness on all area 1-2 years of assignment were not 5 4 4 4.3 CORE
of assignment throughout the shift covered
100% regularly mentors and monitors Nursing 90%-99% of staff were mentored and 4 4 5 4.3 CORE
Attendant I in performing nursing care monitored
procedures
Human Resource All general assemblies, unit meetings, seminars, 3-5 absences 3 4 NA 3.5 CORE
Training & training and other hospital activities are attended
Development with no tardiness recorded
Services
RATING
Total Overall Rating 45 46 45 46.1 6.7
Final Average Rating 4.18 4.18 3.94 4.12 4.24
Adjectival Rating VS VS VS VS
Comments and Recommendation for Development Purposes

Discussed With: Assessed by: Date Final Rating by: Date

I certify that I discussed my assessment of the performance with the employee

Employee Supervisor Next Higher Supervisor

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