EMPLOYEE FEEDBACK FORM

Rating Period

STRENGTHS

DEVELOPMENT
NEEDS

ACTION PLAN
(Recommended Development Intervention)

Employee Feedback:

RM

AN

nt Intervention)

TIMELINE

RESOURCES
NEEDED

PERFORMANCE MONITORING AND COACHING FOR

DATE

CRITICAL INCIDENCE DESCRIPTION

OUTPUT

IMPACT ON
ACTION PL

OACHING FORM
IMPACT ON JOB
ACTION PLAN

SIGNATURE
(RATER/RATEE)

Individual Performance Commitment and Review Form

NORILYN B. ATIENZA
Name of Employee:
Teacher I
Position:
Review Period:
Occidental Mindoro
Bureau/Center/Service/Division:
TO BE FILLED DURING PLANNING

MFOs

KRAs

OBJECTIVES

Basic Education Services

Teaching Learning Process

Prepared LP of activities including

appropriate strategies /approaches with
adequate and updated instructional materials

TIMELINE

Weight
per
Area

Facilitated learning in the class through

functional LP and Innovative teaching
Strategies

Monitored attendance,diversity appreciation,

safe, positive and motivating environment,
overall physical atmosphere, cleanliness and
orderliness of classroom including proper
waste disposal

Pupils/Students Outcomes

Updated class records, test questions and

other record forms in every grading period

Attained at least 75% MPS in all

subjects/learning area every grading period

Achieved 100% promotion rate in every grade

Community Involvement

Updated class records, test questions and

other record forms in every grading period

Attained at least 75% MPS in all

subjects/learning area every grading period

Achieved 100% promotion rate in every

grade

Professional Growth and

Development

Earned 18 masteral units.

Contibuted creative work for school paper

publication.

Initiated/ Participated in co- curricular school

activities such as GSP/BSP Scouting, Kab/Star
Scouting, Langkay/Twinkler Scouting, ICT Festival,
Journalism, Sports, Quiz Bee, MTAP and school monthly
activities .

Received special awards/citation/recognition for

exemplary performance.

w Form

Name of Rater:
Position:
Date of Review:

Medelita M. Varona
Master Teacher I

TO BE FILLED DURING
EVALUATION
PERFORMANCE
INDICATORS
(Quality, Efficiency, Timeliness)

5 - All LP had complete parts with

congruency with complete
supporting evidences.
4 - All LP had complete parts with
congruency with incomplete
supporting evidences.
3 - All LP had complete parts no
congruency with complete
supporting evidences.
2 -All LP had incomplete parts ,
no congruency with complete
supporting evidences.
1 - All LP had incomplete parts ,
no congruency with incomplete
supporting evidences.

ACTUAL
RATING
RESULTS

SCORE*

5 - The teacher facilitated

learning in the class through
functional LP and innovative
teaching strategies with
supporting documents.
4- The teacher developed a
measurable goal for student
learning that is aligned with K to
12 curriculum.
3- The teacher clearly
communicated a focus for student
learning that is appropriate with
K to 12 curriculum.

2- The teacher did not have a

clear focus for student learning.
1-The teacher did not have any
focus for student learning.
5- The teacher checked
attendance and administered
classroom management such as
safety, cleanliness and
orderliness including proper
waste disposal regularly.
4- The teacher checked
attendance and administered
classroom management such as
safety, cleanliness and
orderliness including proper
waste disposal often.

3- The teacher checked

attendance and administered
classroom management such as
safety, cleanliness and
orderliness including proper
waste disposal sometimes.

2-The teacher checked

attendance without administering
classroom management.

1-The teacher did not checked

attendance and administered
classroom management such as
safety, cleanliness and
orderliness including proper
waste disposal.

5-Updated and complete Class

record, test questions and other
school forms in every grading
period and submitted ahead of
time.

4- Updated and complete test

questions, class record and other
school forms submitted just on
time.
3-Updated class record, test
questions and other school forms
and submitted on time but not
complete.

2- Updated and incomplete class

record, test questions and other
school forms submitted late.

1- All test questions, class

records and other school forms
were incomplete and submitted
on time.
5- Attained 76% and above MPS
in all subjects/learning area
every grading period
4-Attained 70-75% MPS in all
subject/learning area every
grading period
3-Attained 65-69% MPS in all
subject/learning area in every
grading period
2-Attained 59-64% MPS in all
subject/learning area in every
grading period
1-Attained 50-58% MPS in all
subject/learning area in every
grading period
5-100% of pupils promoted in
every grade/class
4-99% of pupils promoted in
every grade/class

3-98% of pupils promoted in

every grade/class
2- 97% of pupils promoted in
every grade/class
1-95% of pupils promoted in
every grade/class
5-Updated and complete Class
record, test questions and other
school forms in every grading
period and submitted ahead of
time.
4-Updated and complete test
questions, class record and other
school forms submitted just on
time.
3-Updated class record, test
questions and other school forms
and submitted on time but not
complete.
2- Updated and incomplete class
record, test questions and other
school forms submitted late.
1- All test questions, class
records and other school forms
were incomplete and submitted
on time.
5- Attained 76% and above MPS
in all subjects/learning area
every grading period

4-Attained 70-75% MPS in all

subject/learning area every
grading period
3-Attained 65-69% MPS in all
subject/learning area in every
grading period
2- Attained 59-64% MPS in all
subject/learning area in every
grading period
1-Attained 50-58% MPS in all
subject/learning area in every
grading period
5-100% of pupils promoted in
every grade/class
4-99% of pupils promoted in
every grade/class
3-98% of pupils promoted in
every grade/class
2-97% of pupils promoted in
every grade/class
1- 95% of pupils promoted in
every grade/class
5-Earned 18 units within the
rating period with satisfactory
ratings.

4-Earned 9 units within the rating

period with satisfactory ratings.

3-Earned 6 units within the rating

period with satisfactory ratings.

2-Earned 3 units within the rating

period with satisfactory ratings.
1-No units earned within the
rating period.
5-Contributed 5 creative works for
school paper publication.

4-Contributed 4 creative works for

school paper publication.

3- Contributed 3 creative works

for school paper publication.

2-Contributed 2 creative works for

school paper publication.

1-No contributions of creative

works for school paper
publication.

5-Initiated/ Participated at least 2

co-curricular/ school activities
with documented results

4-Initiated/ Participated school

activities with documented results

3-Participated in most school

activities with documented results

2- Participated only without

documented results.

1-No participation in any of the

school activities.

5-Awarded as Champion winning

coach at least in 2 different
academic/co- curricular activities.

4-Awarded as winning coach at

least in 2 different academic/cocurricular activities.

3-Awarded as winning coach at

least in an academic/cocurricular activities.
2-Participated only in
academic/co- curricular activities.
1- No participation

PART III:

SUMMARY OF RATINGS FOR DISCUSSION

Final Performance Results

Rating

Accomplishments of KRAs by Objectives

Employee-Superior Agreement
The signatures below confirm that the employee and his/her superior have agreed to the contents of the performance as captured in this form.

Name of Employee

Name of Superior

Signature

Signature

Date

Date

PART IV:
Strengths

Development Needs

DEVELOPMENT PLANS
Action Plan
(Recommended Developmental Intervention)

n this form.

Timeline

Resources Needed

Individ

NORILYN B. ATIENZA
Name of Employee:
Teacher I
Position:
Review Period:
Occidental Mindoro
Bureau/Center/Service/Division:

TO BE FILLED DURING P

MFOs

KRAs

Basic Education Services

Teaching Learning Process

OBJECTIVES

Prepared DLL with different a

strategies and approaches wi
instructional materials.

Facilitates learning in the clas

functional LP/ DLL and Innova
strategies and Approaches.

Monitors attendance, cleanlin

classroom management.

Pupils/Students Outcomes Updates class record and othe

40 %
in every grading period.

Attains at least 60% MPS in a

subjects/learning area every g

Achieves 100% promotion rate

Community Involvement

Conducts parents pupils to i

and activities within the

Conducts regular/ period

meetings/conferences 2 times
March

 Visits parents of pupils nee

monitoring/ follow-up / beha
absenteeism 2 times by the

Professional Growth and

Development

Earns 18 masteral units from

Contibutes creative works fo

publication.

Initiates/ Participates in co- curricu

such as GSP/BSP Scouting, Kab/Sta
Langkay/Twinkler Scouting, ICT Fes
Sports, Quiz Bee, MTAP and school

Received special awards/citation/re

exemplary performance.

Individual Performance Commitment and Review Form

Name of Rater:
Position:
Date of Review:

TO BE FILLED DURING PLANNING

OBJECTIVES

LL with different activities,

nd approaches with updated
l materials.

earning in the class through

P/ DLL and Innovative teaching
nd Approaches.

TIMELINE

June to March

Weight
per
Area

PERFORMANCE
INDICATORS
(Quality, Efficiency, Timeliness)

5 -All Daily Lesson Log had

complete parts with congruency
and updated supporting
evidences.
4 - All Daily Lesson Log had
complete parts with congruency
but incomplete with supporting
evidence.

3 - All Daily Log had complete

parts with no congruency with
incomplete supporting evidences

2 -All Daily Lesson Log had

incomplete parts and incomplete
supporting evidences but
submitted on time.

1 - All Daily Lesson Log had

incomplete parts , no congruency
and incomplete supporting
evidences.

June to March

5 - Facilitates learning through

functional LP/ DLL using different
approaches alligned with K to 12
Curriculum

4- Facilitates learning using

some approaches alligned with K
to 12 Curriculum.

3- Facilitates learning without

using different strategies alligne
with K to 12 Curriculum.
2- Facilitates learning without
functional LP/DLL using one
strategy.

1-Facilitates learning without

functional LP/DLL and teaching
strategies.
5- Monitored attendance and
administer classroom
management regularly.

tendance, cleanliness and

management.

ss record and other school forms

ding period.

ast 60% MPS in all

rning area every grading period

4- Monitored and administer

classroom management every
other day.
3- Monitored attendance and
administer classroom
management twice a week.
2- Monitored attendance and
administer classroom
management once a week.

1-Not monitoring attendance and

can't administer classroom
management.

June to March

5-Updated and complete class

record in school forms every
grading period and submitted on
time.
4- Updated and complete class
record and school forms
submitted.
3-Updated and complete class
record with incomplete school
forms submitted late.

2- Updated class record and

incomplete school forms are
submitted late.

1- Class record and school forms

are incomplete and submitted
late.

5- Attained 60 % and above MPS

in all subjects/learning area every
grading period.
4-Attained 50 % MPS and all
subject/learning area every
grading period.

3- Attained 40 % MPS and all

subject/learning area every
grading period.
2- Attained 35 % MPS and all
subject/learning area every
grading period.
1- Attained 20 % MPS and all
subject/learning area every
grading period.
5- Achieved 100 % of pupils
promoted in every grade/class.

100% promotion rate in every grade

4-Achieved 98 % of pupils
promoted in every grade/class.
3- Achieved 96 % of pupils
promoted in every grade/class.
2- Achieved 94 % of pupils
promoted in every grade/class.
1-Achieved 90 % of pupils
promoted in every grade/class.
5-Conducted 100 %
accomplishment with successful
target time.

parents pupils to initiate projects

ivities within the target date.

cts regular/ periodic PTA

nferences 2 times by the end of

4-Conducted 90 %
accomplishment initiated projects
and activities were submitted
within the target date.
3-Conducted 80 % projects and
activities were submitted within
the target date.
2- Conducted 70 % projects and
activities were submitted late.
1- Conducted 50 % projects and
activities were submitted late.

Year Round

(5) Conducted 4 or more planned

meetings producing 4 sets of
agreements with accomplishmen
(4) Conducted 3 planned
meetings producing 3 sets of
agreements and with partial
accomplishment of these

(3) Conducted 2 planned

meetings producing 2 sets of
agreements

(2)Conducted 1 planned meeting

with minimal results
(1) No meetings were conducted
(5) Visited 4 times or more
parents with planned
interventions by the end of
March

rents of pupils needing academic

/ follow-up / behavioral problems/
ism 2 times by the end of March

masteral units from June - March.

s creative works for school paper

publication.

(4) Visited thrice with planned

interventions by the end of
March
(3) Visited twice with planned
interventions by the end of
March
(2) Visited once with planned
interventions
(1) Visitation was not
implemented

June to March

5-Earned 18 units within the

rating period with satisfactory
ratings.

4-Earned 9 units within the rating

period with satisfactory ratings.

3-Earned 6 units within the rating

period with satisfactory ratings.

2-Earned 3 units within the rating

period with satisfactory ratings.
1-No units earned within the
rating period.
June to March

5-Contributed 5 creative works fo

school paper publication.

4-Contributed 4 creative works fo

school paper publication.
3- Contributed 3 creative works
for school paper publication.

icipates in co- curricular school activities

SP Scouting, Kab/Star Scouting,
ler Scouting, ICT Festival, Journalism,
ee, MTAP and school monthly activities .

ial awards/citation/recognition for

formance.

2-Contributed 2 creative works fo

school paper publication.
1-No contributions of creative
works for school paper
publication.

June to March

5-Initiated/ Participated at least 3

co-curricular/school activities with
documented results

4-Initiated/ Participated at least 2

co-curricular/school activities with
documented results.

3-Initiated/ Participated at least 1

co-curricular/school activities with
documented results.
2- Initiated/ Participated without
documented results.
1-No participation in any of the
school activities.

June to March

5-Awarded as champion winning

coach at least 3 different
academic/co- curricular activities
4-Awarded as winning coach at
least in 2 different academic/cocurricular activities.
3-Awarded as winning coach at
least in an academic/cocurricular activities.

2-Participated only in
academic/co- curricular activities
1- No participation in any
activities.

MEDILITA M. VARONA
Master Teacher I

ORMANCE
ICATORS
ciency, Timeliness)

son Log had

with congruency
upporting

sson Log had

with congruency
e with supporting

g had complete
congruency with
pporting evidences.

sson Log had

rts and incomplete
dences but
ime.

sson Log had

rts , no congruency
e supporting

earning through
DLL using different
igned with K to 12

earning using
hes alligned with K
m.

arning without
t strategies alligned
urriculum.

arning without
LL using one

TO BE FILLED DURING
EVALUATION

ACTUAL
RATING
RESULTS

SCORE*

arning without
LL and teaching

ttendance and
ssroom
egularly.

nd administer
nagement every

ttendance and
ssroom
wice a week.

ttendance and
ssroom
once a week.

ng attendance and
er classroom

complete class
ol forms every
and submitted on

d complete class
ool forms

complete class
omplete school
ed late.

ass record and

hool forms are
.

d and school forms

and submitted

% and above MPS

earning area every
.

% MPS and all

g area every
.

% MPS and all

g area every
.

% MPS and all

g area every
.

% MPS and all

g area every
.

0 % of pupils
very grade/class.

% of pupils
very grade/class.

% of pupils
very grade/class.

% of pupils
very grade/class.

% of pupils
very grade/class.

00 %
nt with successful

0%
nt initiated projects
were submitted
et date.

0 % projects and
submitted within
e.

70 % projects and
submitted late.

50 % projects and
submitted late.

4 or more planned
ucing 4 sets of
th accomplishment

3 planned
ucing 3 sets of
d with partial
nt of these

2 planned
ucing 2 sets of

1 planned meeting
esults

s were conducted

mes or more
anned
by the end of

ce with planned
by the end of

e with planned
by the end of

e with planned

as not

nits within the

with satisfactory

ts within the rating

isfactory ratings.

ts within the rating

isfactory ratings.

ts within the rating

isfactory ratings.

ned within the

5 creative works for

ublication.

4 creative works for

ublication.

3 creative works
er publication.

2 creative works for

ublication.

ons of creative
ol paper

ticipated at least 3
chool activities with
esults

ticipated at least 2
chool activities with
esults.

ticipated at least 1
chool activities with
esults.

rticipated without
esults.

ion in any of the

s.

champion winning
3 different
urricular activities.

winning coach at
ent academic/coities.

winning coach at
demic/coities.

only in
urricular activities.

tion in any

Individual Performance Commitment and Review Form

CHARMAGNE ANN K. SANTOS

Name of Employee:
Teacher I
Position:
Review Period:
Occidental Mindoro
Bureau/Center/Service/Division:
TO BE FILLED DURING PLANNING

MFOs

KRAs

Basic Education Services

Teaching Learning Process

OBJECTIVES

Prepared DLL with different activities,

strategies and approaches with updated
instructional materials.

TIMELINE

June to March

Weight
per
Area

Facilitates learning in the class through

functional LP/ DLL and Innovative teaching
strategies and Approaches.

Monitors attendance, cleanliness and

classroom management.

June to March

Pupils/Students Outcomes Updates class record and other school forms

40 %
in every grading period.

Attains at least 60% MPS in all

subjects/learning area every grading period

June to March

Achieves 100% promotion rate in every grade

Community Involvement

Conducts parents pupils to initiate projects

and activities within the target date.

 Conducts regular/ periodic PTA

meetings/conferences 2 times by the end of
March

Visits parents of pupils needing academic

monitoring/ follow-up / behavioral problems/
absenteeism 2 times by the end of March

Year Round

Professional Growth and

Development

Earns 18 masteral units from June - March.

June to March

Contibutes creative works for school paper

publication.

June to March

Initiates/ Participates in co- curricular school activities

such as GSP/BSP Scouting, Kab/Star Scouting,
Langkay/Twinkler Scouting, ICT Festival, Journalism,
Sports, Quiz Bee, MTAP and school monthly activities .

June to March

Received special awards/citation/recognition for

exemplary performance.

June to March

w Form

Name of Rater:
Position:
Date of Review:

MEDILITA M. VARONA
Master Teacher I

TO BE FILLED DURING
EVALUATION
PERFORMANCE
INDICATORS
(Quality, Efficiency, Timeliness)

5 -All Daily Lesson Log had

complete parts with congruency
and updated supporting
evidences.
4 - All Daily Lesson Log had
complete parts with congruency
but incomplete with supporting
evidence.
3 - All Daily Log had complete
parts with no congruency with
incomplete supporting evidences.
2 -All Daily Lesson Log had
incomplete parts and incomplete
supporting evidences but
submitted on time.
1 - All Daily Lesson Log had
incomplete parts , no congruency
and incomplete supporting
evidences.

ACTUAL
RATING
RESULTS

SCORE*

5 - Facilitates learning through

functional LP/ DLL using different
approaches alligned with K to 12
Curriculum

4- Facilitates learning using

some approaches alligned with K
to 12 Curriculum.
3- Facilitates learning without
using different strategies alligned
with K to 12 Curriculum.
2- Facilitates learning without
functional LP/DLL using one
strategy.
1-Facilitates learning without
functional LP/DLL and teaching
strategies.
5- Monitored attendance and
administer classroom
management regularly.
4- Monitored and administer
classroom management every
other day.
3- Monitored attendance and
administer classroom
management twice a week.
2- Monitored attendance and
administer classroom
management once a week.

1-Not monitoring attendance and

can't administer classroom
management.
5-Updated and complete class
record in school forms every
grading period and submitted on
time.
4- Updated and complete class
record and school forms
submitted.
3-Updated and complete class
record with incomplete school
forms submitted late.

2- Updated class record and

incomplete school forms are
submitted late.

1- Class record and school forms

are incomplete and submitted
late.

5- Attained 60 % and above MPS

in all subjects/learning area every
grading period.
4-Attained 50 % MPS and all
subject/learning area every
grading period.
3- Attained 40 % MPS and all
subject/learning area every
grading period.

2- Attained 35 % MPS and all

subject/learning area every
grading period.
1- Attained 20 % MPS and all
subject/learning area every
grading period.
5- Achieved 100 % of pupils
promoted in every grade/class.
4-Achieved 98 % of pupils
promoted in every grade/class.
3- Achieved 96 % of pupils
promoted in every grade/class.
2- Achieved 94 % of pupils
promoted in every grade/class.
1-Achieved 90 % of pupils
promoted in every grade/class.
5-Conducted 100 %
accomplishment with successful
target time.
4-Conducted 90 %
accomplishment initiated projects
and activities were submitted
within the target date.
3-Conducted 80 % projects and
activities were submitted within
the target date.
2- Conducted 70 % projects and
activities were submitted late.

1- Conducted 50 % projects and

activities were submitted late.
(5) Conducted 4 or more planned
meetings producing 4 sets of
agreements with accomplishment
(4) Conducted 3 planned
meetings producing 3 sets of
agreements and with partial
accomplishment of these
(3) Conducted 2 planned
meetings producing 2 sets of
agreements
(2)Conducted 1 planned meeting
with minimal results
(1) No meetings were conducted
(5) Visited 4 times or more
parents with planned
interventions by the end of
March
(4) Visited thrice with planned
interventions by the end of
March
(3) Visited twice with planned
interventions by the end of
March
(2) Visited once with planned
interventions

(1) Visitation was not

implemented
5-Earned 18 units within the
rating period with satisfactory
ratings.
4-Earned 9 units within the rating
period with satisfactory ratings.

3-Earned 6 units within the rating

period with satisfactory ratings.

2-Earned 3 units within the rating

period with satisfactory ratings.
1-No units earned within the
rating period.
5-Contributed 5 creative works for
school paper publication.
4-Contributed 4 creative works for
school paper publication.
3- Contributed 3 creative works
for school paper publication.
2-Contributed 2 creative works for
school paper publication.
1-No contributions of creative
works for school paper
publication.

5-Initiated/ Participated at least 3

co-curricular/school activities with
documented results

4-Initiated/ Participated at least 2

co-curricular/school activities with
documented results.
3-Initiated/ Participated at least 1
co-curricular/school activities with
documented results.
2- Initiated/ Participated without
documented results.
1-No participation in any of the
school activities.
5-Awarded as champion winning
coach at least 3 different
academic/co- curricular activities.
4-Awarded as winning coach at
least in 2 different academic/cocurricular activities.
3-Awarded as winning coach at
least in an academic/cocurricular activities.
2-Participated only in
academic/co- curricular activities.
1- No participation in any
activities.