Department of Education

Region III
Division of Zambales
District of Palauig

BULAWEN ELEMENTARY SCHOOL

INDIVIDUAL PERFORMANCE COMMITMENT AND REVIEW FORM FOR TEACHERS

Name of Employee:___ JEREMY P. DAOS
Position: __________ TEACHER 2 Name of Rater: CHARLES C. FERNAN
Review Period: _____ June 1, 2015- April 1, 2016 Position: PRINCIPAL I
Division/School: Zambales/Santiago Elementary School Date of Review: _________________________________

Major Final Key Weight VERY ACTUAL

Outputs Results Areas OBJECTIVES TIMELINE per PERFORMANCE INDICATORS OUTSTANDING SATISFACTORY SATISFACTORY UNSATISFACTORY POOR RESULTS RATING
(MFOs) (KRAs) Objectives (Quality, Efficiency, Timeliness) (5) (4) (3) (2) (1)
Provision A. Prepare lesson plans June 8% Prepare lesson plans daily Daily lesson Had 4 of the Had 3 of the Had 2 of the Had 1 of the 5 0.400
of and daily logs of acti- 2015- plans had all five parts five parts five parts five parts
Quality vities including ade- March the five (5)
Education quate and updated 2016 parts
instructional materials
B. Facilitate learning in June 8% Make use of innovative Has 5 times Has 4 times Has 3 times Has 2 times Has only one 2 0.160
Teaching- the school through 2015- teaching strategies with and above ICT integration ICT integration ICT integration ICT integration
Learning functional lesson March the help of technology and ICT integration evident per evident per evident per evident per
Process plans, daily logs, and 2016 other gadgets evident per grading period grading period grading period grading period
[30%] innovative teaching grading period
strategies
C. Monitor attendance, June 7% Check daily attendance Attendance Attendance Attendance Attendance Attendance 5 0.350
diversity appreciation, 2015- systematically through checking was checking was checking was checking was checking was
safe, positive and moti- March SF2 and pass it monthly 100% & above 90% system- 80% system- 70% system- 60% system-
vating environment, 2016 systematically atically carried atically carried atically carried atically carried
overall physical atmos- carried out out out out out
phere, cleanliness and 7% Maintain safety, orderliness Safety,orderli- Safety,orderli- Safety,orderli- Safety,orderli- Safety,orderli- 4 0.280
orderliness of class- and cleanliness of floors, ness & cleanli- ness & cleanli- ness & cleanli- ness & cleanli- ness & cleanli-
rooms including proper toilets and proper waste ness & proper ness & proper ness & proper ness & proper ness & proper
 waste disposal daily disposal waste disposal waste disposal waste disposal waste disposal waste disposal
were 100% were 90% were 80% were 70% were 60%
maintained maintained maintained maintained maintained
Provision A. Monitor, evaluate June 5% Pass the class record Class record Class record Class record Class record Class record 5 0.250
of and maintained pupils 2015- and be checked every reflected the reflected the reflected the reflected the reflected the
Quality progress within the March grading period bases of 100% & bases of 90% bases of 80% bases of 70% bases of 60%
Education rating period 2016 above of pupils' of pupils' rating of pupils' rating of pupils' rating of pupils' rating
ratings in all in all classes/ in all classes/ in all classes/ in all classes/
subject areas subject areas subject areas subject areas subject areas
handled handled handled handled handled
Pupils/ June 5% Make use of pupils' Pupils' portfolio Pupils' portfolio Pupils' portfolio Pupils' portfolio Pupils' portfolio 3 0.150
Students 2015- portfolio for all the subjects contained 100% contained 90% contained 80% contained 70% contained 60%
Outcome March and above of his of her/his of her/his of her/his of her/his
[30%] 2016 accomplishment accomplishment accomplishment accomplishment accomplishment
B. Account learning June 5% Overall achievement or 20% has achieved 10%has achieved 80%has achieved 60%has achieved 50%has achieved 3 0.150
outcomes viz-a-viz 2015- pupils' general average the satisfactory the satisfactory the fairly fairly satisfactory the fairly satisfactory
goals and targets March as reflected from SF5 level level satisfactory level level
2016 level
June 5% Maintain participation rate & Zero Drop=out One Drop-out Two Drop-out Three Drop-out Four Drop-out 4 0.200
2015- No Drop-out within the school within the school within the school within the school within the school within the school
March year year year year year year
2016
June 5% Promote the whole class and 100% 90-99% 85-89% 80-85% 75-79% 3 0.150
2015- no failing grade in all subject Promoted & Promoted & Promoted & Promoted & with Promoted & with
March areas no failing grades no failing grades no failing grades one failing grade two failing grades
2016 in all subjects in all subjects in all subjects in some subjects in some subjects
C. Maintain updated Year 5% School records of each pupil Maintained 100% Maintained 90% Maintained 80% Maintained 70% Maintained 60% 5 0.250
thirty five (35) pupils' Round be maintained and updated of 35 pupils' of 35 pupils' of 35 pupils' of 35 pupils' of 35 pupils'
school records school record school record school record school record school record
A. Conduct periodic June 4% Participation of parents 75% & above 70-74% 66-69% 60-65% 50-59% 2 0.080
PTA meetings & 2015 during meeting and other participated participated participated participated participated
conferences March activities during the during the during the during the during the
Community 2016 meeting meeting meeting meeting meeting
 Involvement B. Acquire network of June 4% Programs/projects/activities 4 0.160
15%] support from parents 2015- undertaken sponsored by the five or more four (4) three (3) two (2) one (1)
and community March community and other
2016 stakeholders
C. Develop strong part- June 4% Relationship with stake- No conflict 1 conflict/case 2 conflicts/case 3 conflicts/cases 4 conflicts/cases 5 0.200
nership with parents & 2015- holders elevated to elevated to elevated to elevated to elevated to
community people March higher office higher office higher office higher office higher office
2016
D. Visit/Talk parents of June 3% Visit/Talk parent of pupils Visited/talked Visited/Talked Visited/Talked Visited/Talked VisitedTalked 4 0.120
pupils needing academic 2015- needing academic monitoring 5 parents 4 parents 3 parents 2 parents 1 parent
monitoring/follow-up March or follow-up in a year in a year in a year in a year in a year
within the rating period 2016
Provision A. Participate in higher June 5% Participation in higher level more than 5 5 times 4 times 3 times twice 2 0.100
of level activities or 2015- of activities or contests times
Quality contests April
Education 2016
Professional B. Serve as Facilitator in June 5% Facilitate activities and 3 0.150
Growth any activities at any 2015- demonstrate skills to be Regional Level Division Level District Level Cluster Level School-based
and level March acquired by the pupils Level
Development 2016
[25%] C. Participated/Atttended Year 5% Participation/Attendance Attended Attended Attended Attended Attended 4 0.200
Trainings/Workshops Round in any training/workshops International National level Division level District level School level
for Teachers within for teaachers training within training within training within training within training within
the school year the school year the school year the school year the school year the school year
D. Serve as coach and July 5% Participate and garner 3 0.150
garner major awards 2015- awards at higher level Provincial Zonal District Unit School-based
at any higher level March of competition Level Level Level Level Level
competition 2016
E. Serve as school paper Year 5% Participate and garner 5 0.250
adviser and garner Round awards at higher level National Provincial Division Level District School-based
major award at any of competition Level Level Level Level
higher level competition
Legend: 4.500-5.000 - OUTSTANDING 3.500-4.499 - VERY SATISFACTORY 2.500-3.499 - SATISFACTORY 1.500-2.499 - UNSATISFACTORY 1.000 -1.499 -POOR
Very Satisfactory
 Very Satisfactory
OVERALL RATING

RATEE: RATER: APPROVING AUTHORITY:

MARGIE E. FUERTES LORENA M. NAVARRO ZENIA G. MOSTOLES, ED.D.,CESO V

Teacher III Principal I Schools Division Superintendent
SCORE
1.190

1.000
0.560

0.850
3.600
3.600
 Department of Education
Region III
Schools Division of Zambales
Botolan District

SANTIAGO ELEMENTARY SCHOOL

INDIVIDUAL PERFORMANCE COMMITMENT AND REVIEW FORM FOR TEACHERS

Name of Employee: WILLIE A. DOMACENA
Position: TEACHER II Name of Rater: LEONORA O. PLOMANTES
Review Period: June 2017 - April 2018 Position: MASTER TEACHER I
Division/School: Zambales/Santiago Elementary School Date of Review: _________________________________

Major Final Key Weight VERY ACTUAL

Outputs Results Areas OBJECTIVES TIMELINE per PERFORMANCE INDICATORS OUTSTANDING SATISFACTORY SATISFACTORY UNSATISFACTORY POOR RESULTS RATING SCORE
(MFOs) (KRAs) Objectives (Quality, Efficiency, Timeliness) (5) (4) (3) (2) (1)
5 0.400
A. Prepare weekly lesson
plans of activities including June 2017 Daily lesson plans Daily lesson plans Daily lesson plans Daily lesson plans Daily lesson plans
adequate and updated to April 8% Prepare weekly lesson plans had all the five (5) had all the ffour had all the three had all the two (2) had all the one (1)
2018 parts (4) parts (3) parts parts part
instructional materials.

B.Facilitate learning in the 5 0.300

school through functional Make use of innovative Has 4 times and Has 3 times and Has 2 times and Has 1 time and
Has 5 times and
teaching strategies with the above ICT above ICT above ICT above ICT
lesson plans, daily logs, and 6% above ICT integration integration integration integration evident
innovative teaching help of technology and other integration evident evident per evident per evident per per grading
strategies. gadgets. per grading period. grading period. grading period. grading period. period.
June 2017
to April 5 0.300
Engage students in learning
2018 activities through : Conducted
Teaching- a. Role Playing Conducted 4 Conducted 3 Conducted 2 1learning Initiated but not
Provision of Learning 6% b. Dramatization
learning activities learning activities learning activities activities and materialized
Quality and above and above and above
Education Process c. Group Activity above
(30%) d. Drawing

Attendance Attendance Attendance Attendance Attendance 5 0.250

Check daily attendance checking was checking was 90% checking was 80% checking was 70% checking was 70%
C. Monitor attendance, 5% systematically through SF2 and 100% & above & above & above & above & above
diversity appreciation, safe, pass it monthly. systematically systematically systematically systematically systematically
carried out. carried out. carried out. carried out. carried out.
positive and motivating
June 2017
environment, overall
physical atmosphere,
to April 4 0.200
2018 Maintain safety, orderliness Safety,orderliness Safety,orderliness Safety,orderliness Safety,orderliness Safety,orderliness
cleanliness and orderliness
of class waste disposal and cleanliness of floors, & cleanliness & & cleanliness & & cleanliness & & cleanliness & & cleanliness &
daily. 5% toilets and proper waste
proper waste proper waste proper waste proper waste proper waste
disposal were disposal were 90% disposal were 80% disposal were 70% disposal were 60%
disposal. 100% maintained. maintained. maintained. maintained. maintained.
1.450
Pass the class record Class record Class record Class record Class record Class record 5 0.250
and be checked every reflected the reflected the reflected the reflected the reflected the

June 2017 grading period bases of 100% & bases of 90% bases of 80% bases of 70% bases of 60%
to April 5% above of pupils' of pupils' rating of pupils' rating of pupils' rating of pupils' rating
2018
A. Monitor, evaluate and ratings in all in all classes/ in all classes/ in all classes/ in all classes/
maintained pupils progress subject areas subject areas subject areas subject areas subject areas
within the rating period.
handled handled handled handled handled
Make use of pupils' Pupils' portfolio Pupils' portfolio Pupils' portfolio Pupils' portfolio Pupils' portfolio 5 0.250
June 2017 portfolio for all the subjects contained 100% contained 90% contained 80% contained 70% contained 60%
to April 5%
2018 and above of his of her/his of her/his of her/his of her/his
accomplishment accomplishment accomplishment accomplishment accomplishment

Pupils/Stude B. Account learning 5% Overall achievement or 20% has achieved 10%has achieved 80%has achieved 60%has achieved 50%has achieved 5 0.250
Provision of nts outcomes vis-a-vis June 2017 pupils' general average the satisfactory the satisfactory the fairly fairly satisfactory the fairly
Quality to April
Education outcomes goals and targets 2018 as reflected from SF5 level level satisfactory level satisfactory level
(30%)
level
5% Maintain participation rate & Zero Drop=out One Drop-out Two Drop-out Three Drop-out Four Drop-out 5 0.250
June 2017 No Drop-out within the school within the school within the school within the school within the school within the school
to April
2018 year year year year year year

5% Promote the whole class and 100% 90-99% 85-89% 80-85% 75-79% 5 0.250
June 2017 no failing grade in all subject Promoted & Promoted & Promoted & Promoted & with Promoted & with
to April
2018 areas no failing grades no failing grades no failing grades one failing grade two failing grades
in all subjects in all subjects in all subjects in some subjects in some subjects
C. Maintain updated 5% School records of each pupil Maintained 100% Maintained 90% Maintained 80% Maintained 70% Maintained 60% 5 0.250
Year
thirty-one (31) pupils' Round be maintained and updated of 31 pupils' of 31 pupils' of 31 pupils' of 31 pupils' of 31 pupils'
school records school record school record school record school record school record 1.250
A. Conduct periodic 4% 75% & above 70-74% 66-69% 60-65% 50-59% 4 0.160
PTA meetings & June 2017 Participation of parents during participated participated participated participated participated
to April
conferences 2018 meeting and other activities. during the during the during the during the during the
meeting meeting meeting meeting meeting
B. Acquire network of 4% Programs/projects/activities 5 0.200
support from parents June 2017 undertaken sponsored by the five or more four (4) three (3) two (2) one (1)
to April
and community 2018 community and other
Provision Community stakeholders
of Quality Involvement
Education (15%) C. Develop strong part- 4% Relationship with stake- No conflict 1 conflict/case 2 conflicts/case 3 conflicts/cases 4 conflicts/cases 5 0.200
nership with parents & June 2017 holders elevated to elevated to elevated to elevated to elevated to
to April
community people. 2018 higher office higher office higher office higher office higher office

3% Visited/talked Visited/Talked Visited/Talked Visited/Talked VisitedTalked 4 0.120

D. Visit/Talk parents of
pupils needing academic June 2017 Visit/Talk parent of pupils 5 parents 4 parents 3 parents 2 parents 1 parent
to April needing academic monitoring or
monitoring/follow-up 2018 follow-up in a year in a year in a year in a year in a year
within the rating period.
0.680
 A. Participated/Attended Participation/Attendance in Attended 10 Attended 5 days Attended 3 days Attended 2 days Attended 1 day
Trainings/Workshops for Year
10% any training/workshops for days training training within training within training within training within 5 0.500
Teachers within the school Round within the the school year the school year the school year the school year
year. teachers school year

Provision of Professional
Quality Growth and 4 0.400
B. Participated or/and Paticipated Paticipated Paticipated Paticipated Paticipated
Education development received awards at any Year Participate or/and garner or/and garnered or/and garnered or/and garnered or/and garnered or/and garnered
(25%) 10%
level competition within Round awards within a year National Level Regional Level Division Level District Level School-Based
the year. Competition Competition Competition Competition Competition

5 or more 4 3 2 1 5 0.250
C. Served as coordinators June Served as coordinators in any coordinatorships coordinatorship coordinatorship coordinatorship coordinatorship
2017 to
or in any working April 5% working committee in the or in any s or in any s or in any s or in any or in any
committee in the school. 2018 school working working working working working
committee committee committee committee committee 1.150
Legend: 4.500-5.000 - OUTSTANDING 3.500-4.499 - VERY SATISFACTORY 2.500-3.499 - SATISFACTORY 1.500-2.499 - UNSATISFACTORY 1.000 -1.499 -POOR
Very Satisfactory 4.530
OVERALL RATING

RATEE: RATER: APPROVING AUTHORITY:

WILLIE A. DOMACENA LEONORA O. PLOMANTES ELSIE T. RAMOS

Teacher II Master Teacher I Head Teacher II
 PART III: SUMMARY OF RATINGS FOR DISCUSSION
Final Performance results Rating Adjectival Rating

Accomplishments of KRAs and Objectives 4.530 Outstanding

Rater- Ratee Agreement

The signatures below confirm that the employee and his/her superior have agreed on content of this appraisal form and the performance rating.

Name of employee WILLIE A. DOMACENA Name of Superior ELSIE T. RAMOS

Signature Signature
Date Date

PART IV: DEVELOPMENTAL PLANS

Action Plan (Recommended

Strengths Developmental Needs Developmental Intervention) Timeline Resources Needed

Visit/Talk parent of pupils needing Assign schedule per pupil every

Make use of innovative teaching academic monitoring or follow-up week for home visitation with or
strategies with the help of without problems in the classroom. Year Round Time
technology and other gadgets.

Maintained up-to-date learners' Participation of parents during meeting Encourage more active Parent-
records and other activities. Teacher relationship
Year Round Human Resources

WILLIE A. DOMACENA LEONORA O. PLOMANTES ELSIE T. RAMOS

Teacher II Master Teacher I Head Teacher II
(Ratee) (Rater) (Rater)

DepEd RPMS Form for Teachers