Rey Anne

PERFORMANCE EVALUATION FORMFor the rating period of January 2015 to June 2015

EMPLOYEE : _REYANNE C PARALE RNMUNICIPALITY:___ Rodriguez

PART I. PERFORMANCE

Work-KRA/ Activity Unit of Measure/indicatorTARGETS RATINGS

QUANTITY QUALITY TIME SUPERVISOR EMPLOYEE

(%) Target Accomp. Target Accomp. Target Accomp. QN QL T APS EPS QN QL T APS EPS

32% #DIV/0! ### #DIV/0! #DIV/0!

A.1 Attendance to pre-natal cases 30 85.00 20

A.2Attendance / Assistance to Deliveries

A.3 Attendance to Post Natal Care 10 85.00 30

Total Equivalent Point Score (EPS)

Multiply by Percentage Weight Allocation (70%)

Weighted Average Score (WAS) ### #DIV/0! WE DISCUSS AND AGREE ON THE ABOVE TARGETS: Legend: PERC Action:

QN - Quantity

QL - Quality

DENNIS B. VILLANUEVA, RN REYANNE C PARALE RN FEB. 13, 2015 T - Time

Rater Ratee Date APS - Ave. Point Score

EPS - Equivalent Point Score

POSITION : _ NDP NURSE I________

Weight Allocation

Total Number of Targets for

Activity A.Average % for

Activity AAverage time for

activity A

A. Assists in the implementation of various health programs of the local Gov't Unit in accordance with the program goals and objectives of the DOH and the Health Sector.

Qty:Number Attendance to Pre-Natal attended Qlty:% Accuracy (effectivity,Safetiness) Time:No. of minutes per attendance

Qty:Number of attendance / Assistance to deliveries Qlty:% Accuracy (effectivity,Safetiness) Time:No. of minutes (or hours) per attendance /assistance

Qty:Number of attendance to Post Natal Care Qlty:% Accuracy (effectivity,Safetiness) Time:No. of minutes (or hours) per attendance


MUNICIPALITY:___ Rodriguez

PART I. PERFORMANCE




A.4 Participate / Assist in EPI

BCG 35 86% 15Hepa at Birth

70 70 89% 10OPV 70 89% 10Measles 30 85% 10

MMR 30 85% 10

13% 10 85% 40

5% 3 85% 30

5% 3 85% 40 #DIV/0! ### 0.00

Total Equivalent Point Score (EPS)

Multiply by Percentage Weight Allocation (70%) ### 0.00

Weighted Average Score (WAS)

WE DISCUSS AND AGREE ON THE ABOVE TARGETS: Legend: PERC Action:

QN - Quantity

QL - Quality




EMPLOYEE : _REYANNE C PARALE RNPOSITION : _ NDP NURSE I________

Weight Allocatio

n

Qty:Number of EPI Participation / Assistance per antigen Qlty: % effectivity Time:No. of minutes per participation/assistance

B. Conduct Health Program Education / Advocacy (Breast Feeding, Family Planning, Healthy Lifestyle, Resp. pet ownership etc)

QTY: No. of HE/ Advocacy Conducted Qlty: % effectivity Time: No. min (hrs) per activity

C. Assist in screening of presumptive TB cases, Admission of TB Cases & follow up of enrolled TB Cases

Qty: Number of screening,Admission & follow ups conducted Qlty: % effetiveness Time: No of minutes per follow up

D. Conduct HL related diseases screening activities(CVD,DM,Ca, etc)

Qty: No. of HL Screening Conducted Qlty: % Accuracy Time:No. of minutes(hrs) per client


EMPLOYEE : _REYANNE C PARALE RNMUNICIPALITY:___ Rodriguez

PART I. PERFORMANCE




10% 5 85.00 45 #DIV/0! ### #DIV/0! #DIV/0!

5% 3 85.00 45 #DIV/0! ### #DIV/0! #DIV/0!

5% 5 88.00 45 #DIV/0! ### #DIV/0! #DIV/0!

10% 3 85.00 45 #DIV/0! ### #DIV/0! #DIV/0!

10% 6 90.00 DEADLINE #DIV/0! ### #DIV/0! #DIV/0!

5% 2 85.00 60 #DIV/0! ### #DIV/0! #DIV/0!

Total Equivalent Point Score (EPS)100% Multiply by Percentage Weight Allocation (70%) ### #DIV/0!

Weighted Average Score (WAS)

WE DISCUSS AND AGREE ON THE ABOVE TARGETS: Legend: PERC Action:

QN - Quantity

QL - Quality


POSITION : _ NDP NURSE I________

Weight Allocatio

n

E. Assist in recording, report analysis & reporting (ex.FHSIS)

Qty: No.Assistance provided Qlty: % Effectivity Time: No. of minutes(hrs) per Assistance

F. Provide Assistance in the conduct of disease surveillance

Qty: No. of Assistance provided Qlty: % Effectivness /Acceptability Time: No. of minutes(hrs) per Assistance

G. Assists in the supervision and monitoring of the CHT

Qty: No. of Assistance provided Qlty: % Effectivity / Acceptability Time: No. of minutes(hrs) per Assistance

H. Assists in the conduct of regular monitoring and evaluation of the various

health programs for the community

Qty: No. of Assistance provided Qlty: % Effectivity / Acceptability Time: No. of minutes(hrs) per Assistance

I. Timely Submission of monthly accomplishment reports, DTR and other rerports as required to include incidental reports to the CHD

Qty: No. of Submitted Reports as required Qlty: % completeness and Acceptability Time: Deadline

J. Perform other related functions in accordance with NDP AO

Qty: No. of activity conducted Qlty: %effectivness / acceptability Time: No. of hrs/activity



### #DIV/0!

Part II. Critical Factors ( 30 % )Behavioral Factors Self Rating ( 15 %) Supervisor Rating ( 70 % ) Subordinate Rating Peer Rating ( 15 % )

A1. COURTESY #DIV/0!2. HUMAN RELATIONS #DIV/0!3. INTEGRITY #DIV/0!4. STRESS TOLERANCE #DIV/0!5. INITIATIVE / RESOURCEFULLNESS #DIV/0!6 COMPLIANCE TO OFFICE RULES AND REGULATIONS #DIV/0!7. PUNCTUALITY AND ATTENDANCE #DIV/0!

Total Point Score ( TPS ) Divide by number of entries Average Point Score #DIV/0! #DIV/0! #DIV/0! COMMENTS AND RECOMMENDATION BY THE IMMEDIATE SUPERVISOR

Strong Point Weak Point Recommendations

SUMMARY OF RATINGSAverage Percentage Weight Allocation Weighted Ave. Average Percentage Weigth Allocation Weighted Ave.

RATER Point Score With Without Score(WAS) Point Score With Without Score (WAS)(Part 1) Subordinate Subordinate Part 1 Part II Subordinate Subordinate Part II

Supervisor Rater #DIV/0! 60% 65% #DIV/0! #DIV/0! 70% 70% ###Self- Rater #DIV/0! 30% 35% #DIV/0! #DIV/0! 10% 15% ###Subordinate - 10% 10%Peer Rater - #DIV/0! 10% 15% ###

Total Weighted Average Score ( TWAS) #DIV/0! ###

Total Weighted Average Score (WAS) x 70% Part I = X 70% = #DIV/0! Total Weighted Average Score (TWAS) x 30% (Part II) x 30% = #DIV/0! Total Overall Score ( TWAS) Part 1 + TWAS Part II) #DIV/0! Add : Intervening Task ( If Any ) ________ Find Numerical Rating 8.00 Adjectival Rating VS

Jan-15 ___________________________________ _______________ Rater Ratee Date Confirmed by Next Higher Date

Supervisor

PERC Chairman

8. LEADERSHIP ( for supervisors only )

Rey Anne

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