Reference Code:

MCC-QF-HRM-001
Republic of the Philippines
Revision No:
Department of Health 1
DAVAO REGIONAL MEDICAL CENTER Effective Date:
April 1, 2018
COMPETENCY ASSESSMENT FORM

Section A. Personal Information

Name of Employee Age:
Position Designation/s:
Division/ Section
Assigned
Section B. Education/ Eligibility and Experience
Highest Educational Course/Degree
Attainment
Eligibility/ie Exp. Date: Post
s: Graduate
No. of years No. of years in No. of years in
in the the designation experience
position relevant to function

Section C. Knowledge and Skills

3 = Knowledgeable/Skilled = The employee achieved the necessary competence required of his/her
position. Knowledge or skill is beingdemonstrated on a consistent basis. No intervention is required.
2 = Needs Improvement = The necessary competence in terms of knowledge and skills is not yet fully
achieved. Improvement need to be made. Intervention is required
1 =Zero Knowledge or Skills= The employee was not able to perform or demonstrate the skill
assigned to him/her. This usually happens to those who are newly hired. Significant intervention is
required.

Wherever practicable, examinations will be given to the employee to assess knowledge on subject matters
related to their function.
Knowledge and Skills Rating Intervention
(If rating is 1 or 2)

Exclusively Owned by Davao Regional Medical Center Page 1 of 2

 Reference Code:
MCC-QF-HRM-001
Republic of the Philippines
Revision No:
Department of Health 1
DAVAO REGIONAL MEDICAL CENTER Effective Date:
April 1, 2018
COMPETENCY ASSESSMENT FORM

Rater:

___________________________________ ______________
Signature over printed Name of Supervisor Date

Conformed:

___________________________________ ______________
Signature over printed Name of Employee Date

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