DOH - SPMS Form

INDIVIDUAL PERFORMANCE COMMITMENT AND REVIEW (IPCR)

I, NAME OF HRH , Nurse II of the Department of Health Center For Health Development Northern Mindanao commit to deliver and agree to be rated on the attainment of th
folllowing of the targets in accordance with the indicated measures for the period of July to December 2019.

Name of Employee: NAME OF HRH

NURSE II
Approved By: Date
NAME OF DMO IV
DATE FILED
DMO IV
5 – Outstanding
4 – Very Satisfac
3 – Satisfactory
2 - Unsatisfactory
1 - Poor
RATING SCALE

RATING
Success indicator
Output Actual Accomplishment QTY QLY T A
(Target + Measure)
(1) (2) (3) (4)

CORE FUNCTIONS:

Visited __ households under all

Visit ___ households under all priority household on
1. Conducts regular visits to all priority households priority household on scheduled ###
scheduled date and without minimal complaints.
date without complaints.

Planned __ interventions for the

identified health concerns of
Plan___ interventions for the identified health
2. Plans for appropriate interventions on the health families under all priority
concerns of families under all priority household ###
concerns of the all priority households household prepared __ days
prepared on scheduled date and with minimal error
ahead of scheduled date and with
no error

Submited and prepared __health

Submit and prepare __health status reports of
3. Prepares and Submit health status report based
families based on all priority households on
on all priority households
scheduled date and with minimal error.
status reports of families based on
all priority households __ days ###
ahead of scheduled date and with
no error.

Output
4. Assists in the conduct of regular monitoring and
evaluation of various health programs under
priority households
5. Conducts health education activities
6. Assists in the conduct of disease surveillance
Success indicator
(Target + Measure)
Profile, assess and give services (TSEKAP) to ___
priority families within set schedule with all aspect of families ___ days ahead of
work and with minimal complaints.
a. Conduct __ mother's class/purok household's
class/pabasa/fp usapan series/FDS within set
schedule with all aspect of work assignment
thoroughly covered and with minimal complaints.
b. Conduct ____IEC activities on HIV/AIDS on
scheduled date and with minimal complaints.
c. Conduct ____IEC activities on TB Program on
scheduled date and with minimal complaints.
d. Conduct ____IEC/advocacy on Blood Donation on Blood Donation ____ days ahead
scheduled date and with minimal complaints.
e. Conduct ____IEC/advocacy on Teenage
Pregnancy on scheduled date and with minimal
complaints.
f. Conduct ____IEC/advocacy on Healthy Young
Ones/AJA on scheduled date and with minimal
complaints.
g. Conduct ____IEC/advocacy/activities to ensure
implementation of nutrition Program in the LGU on
scheduled date and with minimal complaints.
a. Monitor ___ adverse events of vaccines and
reports accurately within 24 hours upon occurrence
and with minimal error.
RATING
Actual Accomplishment QTY QLY T A
(1) (2) (3) (4)
Profiled, assessed and gave
services (TSEKAP) to ___ priority
###
schedule with all aspect of work
and with no complaints.
Conduct __ mother's class/purok
household's class/pabasa/fp
usapan series/FDS ___ days
ahead of scheduled date with all ###
aspect of work assignment
thoroughly covered and with no
complaints.
Conducted ____IEC activities on
HIV/AIDS ____ days ahead of
###
scheduled date and with no
complaints.
Conducted ____IEC activities on
TB Program ____ days ahead of
###
scheduled date and with no
complaints.
Conducted ____IEC/advocacy on
###
of scheduled date and with no
complaints.
Conducted ____IEC/advocacy on
Teenage Pregnancy ____ days
###
ahead of scheduled date and with
no complaints.
Conducted ____IEC/advocacy on
Healthy Young Ones/AJA ____
###
days ahead of scheduled date and
with no complaints.
Conduct ___ IEC/advocacy/
activities to ensure implementation
of nutrition Program in the LGU ###
____ days ahead of date and with
no complaints.
Monitored ___ adverse events of
vaccines and reported accurately
###
within 24 hours upon occurrence
and with no error.
 RATING
Success indicator
Output Actual Accomplishment QTY QLY T A
(Target + Measure)
(1) (2) (3) (4)
6. Assists in the conduct of disease surveillance
Reported ____ weekly notifiable
b. Report ____ weekly notifiable diseases (Category
diseases (Category 2) accurately ###
2) accurately and on-time with minimal error.
and on-time with no error.

Facilitated collection and

7. Participates in data gathering and response
during health emergencies and disasters
a. Facilitate collection and submission of ___
validated Rapid Health Assessment Conducted on
Health Events with all aspects covered within 24
hours with minimal error
submission of ___ validated Rapid
Health Assessment Conducted on
###
Health Events with all aspects
covered within ___ hours with no
error

b. Identify ___ vulnerable ages and individuals Identified ___ vulnerable ages and
###
accurately with minimal error individuals accurately with no error

Maintained and Covered 1

Maintain and Cover 1 Barangay Health Station/s
8. Maintains Barangay Health Station/s Barangay Health Station/s ###
thoroughly without complaints.
thoroughly without complaints.

Coordinated with the public health

Coordinate with the public health associates in the
9. Coordinates with the public health associates in
data collection and reporting of 48 Reports on
the data collection and reporting
scheduled date with minimal errors
associates in the data collection
and reporting of 48 Reports ___ ###
days ahead of scheduled date
with no errors

Gave Quality Prenatal Care to

a. Give Quality Prenatal Care to ____Pregnant
____Pregnant Women ____ days
Women on the scheduled date and with minimal ###
ahead of scheduled date and with
complaints.
no complaints.

Followed up and gave FP services

b. Follow up and give FP services to __ women with
to __ women with unmet need ___
unmet need on the scheduled date and with minimal ###
days ahead of scheduled date and
complaints.
with no complaints.

Tracked and referred high risk

c. Track and refer high risk ___ Pregnant women for ___ Pregnant women for hospital
hospital delivery on scheduled date with minimal delivery ___ days ahead of ###
complaints. scheduled date and with no
complaints.
 RATING
Success indicator
Output Actual Accomplishment QTY QLY T A
(Target + Measure)
(1) (2) (3) (4)

Monitored ___ 0-6 Months

d. Monitor ___ 0-6 Months Exclusively BreastFeeding
Exclusively BreastFeeding ###
Accurately and with minimal error
Accurately and with no error

Followed up and referred ____

e. Follow up and refer ____ Pregnant women for FBD Pregnant women for FBD ___
10. Assists in the implementation of various health ###
on scheduled date and with minimal complaints. days ahead of scheduled date and
programs of the Local Government Unit in
with no complaints.
accordance with the program goals and objectives
of the Universal Health Care Gave Quality Postpartum Care to
f. Give Quality Postpartum Care to ____Post Partum
____Post Partum Mothers on the
Mothers on the scheduled date and with minimal ###
scheduled date and with no
complaints.
complaints.

g. ___Fully immunize children on scheduled date and g. ___Fully immunized children on

###
with minimal error. scheduled date and with no error.

Tracked ___ Immunization

h. Track ___ Immunization defaulter on scheduled defaulter ___ days ahead of
###
date and with minimal complaints scheduled date and with no
complaints.

Assessed and diagnosed __

i. Assess and diagnose __children based on IMCI children based on IMCI protocol
###
protocol on scheduled date and with minimal error. on ___ days ahead of scheduled
date and with no error.

Monitored ___ "Sabayang 4

j. Monitor ___ "Sabayang 4 o'clock Habit" on
o'clock Habit" ___ days ahead of ###
scheduled date and with minimal complaints.
scheduled date and with no error.

Attended ___ Inter-Agency

11. Partnership, Collaboration and Networking Attend ___ Inter-Agency Meetings within 8 hours with
Meetings within 8 hours with 100% ###
Activities 100% attendance and participation.
attendance and participation.

Facilitated collection and

a. Facilitate collection and submission of 6 Monthly
submission of 6 Monthly Inventory
Inventory of Equipments on scheduled date with ###
of Equipments ___ days ahead of
minimal error.
scheduled date and with no error.
 RATING
Success indicator
Output Actual Accomplishment QTY QLY T A
(Target + Measure)
(1) (2) (3) (4)
Facilitated collection and
b. Facilitate collection and submission of 6 Monthly submission of 6 Monthly Inventory
12. Management of Resources Inventory of Supply Chain Management on scheduled of Supply Chain Management ___ ###
date with minimal error. days ahead of scheduled date and
with no error.
Facilitated collection and
c. Facilitate collection and submission of 6 Monthly submission of 6 Monthly Inventory
Inventory of all DOH Commodities on scheduled date of Supply Chain Management ___ ###
with minimal error. days ahead of scheduled date and
with no error.

Conducted 6 Monthly BHW and

a. Conduct 6 Monthly BHW and other volunteers
other volunteers meeting within 8
meeting within 8 hours with 100% attendance and ###
hours with 100% attendance and
minimal complaints.
no complaints.
13. Leadership and Management
Conducted 6 Monthly HPN/DM
b. Conduct 6 Monthly HPN/DM Club meeting within 8 Club meeting within 8 hours with
###
hours with 100% attendance and minimal complaints. 100% attendance and no
complaints.

Attended 6 Monthly Staff meeting

a. Attend 6 Monthly Staff meeting within 8 hours with within 8 hours with 100%
###
100% attendance and with minimal complaints. attendance and with no
complaints.
14. Professional/Personal Development
Attended ____ Other meetings (e.i
b. Attend ____ Other meetings (e.i Team Leaders,
Team Leaders, Officers) within 8
Officers) within 8 hours with 100% attendance and ###
hours with 100% attendance and
with minimal complaints.
with minimal complaints.

Perform other health related functions as may be assigned. 0 0 0 ###

Consolidated and submited ___

a. Consolidate and submit ___ Reports accurately on Reports accurately on ___ days
###
scheduled date and with minimal error. ahead of scheduled date and with
____ error.
1. Acts as Assistant Program Coordinator (Optional)
 RATING
Success indicator
Output Actual Accomplishment QTY QLY T A
(Target + Measure)
(1) (2) (3) (4)
1. Acts as Assistant Program Coordinator (Optional)
Conducted and documented ____
b. Conduct and document ____ Coordinative
Coordinative activities on
activities on scheduled date with 100% participation ###
scheduled date with 100%
and minimal complaints.
participation and no complaints.

___ Assist/Encoding of data as scheduled date and __Assist/Encoding of data as

2. EMR functionality/institutionalization (Optional) ###
with minimal error. scheduled date and with no error.

Facilitated collection and

Facilitate collection and consolidation of 6 Monthly consolidation of 6 Monthly Payroll
3. DTRs/Payroll (Optional) Payroll of DTRs and other Monthly Accomplishments of DTRs and other Monthly ###
on scheduled date with minimal errors Accomplishments on scheduled
date with no errors

Monitored through Electronic

Monitor through Electronic Monitoring ____ HRHDP
4. Daily HRHDP 2019 E-Monitoring (Optional) Monitoring ____ HRHDP 2019 ###
2019 Excellently and with minimal error.
Excellently and with no error.

RATING 0 0 0 ###

Total Overall Rating Core Function (3+2+5)/3 x70%= 2.3 Support Function (5+5)/2 x 30% = 1.5 0 0 0

Final Average Rating #DIV/0!

Adjectival Rating

Comments and Recommendation for Development Purposes

Discussed with: Assessed by: Date Final Rating by:

I certify that I discussed my assessment of the perfomance with the
employee
DATE
NAME OF HRH MHO/CHO NAME OF DMO IV
FILED
Employee Supervisor DEVELOPMENT MANAGEMENT OFFICER IV

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

 DOH - SPMS Form 3
REVIEW (IPCR)

commit to deliver and agree to be rated on the attainment of the

9.

Date

DATE FILED

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

Remarks
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#DIV/0!
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#DIV/0!

Date