Republic of the Philippines

Department of Health
Regional Field Office No. 3
JOSE B. LINGAD MEMORIAL REGIONAL HOSPITAL
City of San Fernando, Pampanga

DIVISION PERFORMANCE COMMITMENT AND REVIEW (DPCR)

I,___________________________, Division Chief of the ____________________________________, commit to deliver and agree to be rated on the attainment of the following targets in accord
measures for the period _______________ to __________________, 20_____.

Name of Division Chief: ___________________________________________ Date: ___

Approved By: Date

Name of Supervisor

RATING SCALE

Section/ Employee RATING

Major Final Output Success Indicators Alloted Budget Actual Accomplishment
Accountable Q 1
E2 T3
 Section/ Employee RATING
Major Final Output Success Indicators Alloted Budget Actual Accomplishment
Accountable Q 1
E2 T3

RATING
Total Overall Rating
Final Average Rating
Adjectival Rating
Comments and Recommendation for Development Purposes (Please do not leave this blank)

Discussed With: Assessed by: Date Final Rating by:

I certify that I discussed my assessment of the perfomance with the employee

Employee Supervisor Next Higher Supervisor

Legend: 1- Quality 2 -Efficiency 3 - Timeliness 4 - Average
of the Philippines
ment of Health
Field Office No. 3
ORIAL REGIONAL HOSPITAL
Fernando, Pampanga

OMMITMENT AND REVIEW (DPCR)

mmit to deliver and agree to be rated on the attainment of the following targets in accordance with the indicated

Date: ________________________

Date

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

RATING
Remarks
A4
 RATING
Remarks
A4

Final Rating by: Date

Next Higher Supervisor

 Republic of the Philippines
Department of Health
Regional Field Office No. 3
JOSE B. LINGAD MEMORIAL GENERAL HOSPITAL
City of San Fernando, Pampanga
INDIVIDUAL PERFORMANCE COMMITMENT AND REVIEW (IPCR)

I,__________________, of the Pediatric Department commit to deliver and agree to be rated on the attainement of the following targets in accordance with the indicated measures for the period of July to December, 2020.

Equivalent Weight of Ouput

Functions Strategic Core Support (name of staff)
Weight 30% 40% 30% Ratee Name

Approved by Date
Laila L. Quiding
July 01,2020
Name of Supervisor
5 – Outstanding
4 – Very Satisfactory
3 – Satisfactory
2 - Unsatisfactory
1 - Poor

Major Final Output/ Rating

Success Indicators
Program, Activity & Actual Accomplishments (d) Remarks
(Targets + Measures)
Project/Deliverable (c) (e)
(b) Q1 E2 T3 A4
(a)
A.Strategic Functions (30%)

Implemantation of training plan for 70% Quality assessment and monitoring of

Quality Health Care of cardiovascular and neurological patients 100% Quality assessment and monitoring of
5.00 NA NA 5.00
Cardiovascular and Neurological through the utilization of the neonatal and cardiovascular and neurological patients utilized
patients in ICU pediatric intensive care unit 24 hour flow sheet

sub total for strategic functions (30 %) 5.00

B. Core Functions: (40 %)
Q- 80% compliance to protocol on receiving and 90 % compliance by pediatric nursing staff to protocol
4.00 NA NA 4.00
endorsing of patients on receiving and endorsing of patients

Q- 80 % compliance to receiving and endorsing 90 % compliance to receiving and endorsing

4.00 NA NA 4.00
Quality of patient care in the ward medicines, supplies, and equipment protocol medicines, supplies, and equipment protocol

Q- 90% compliance to safe medication practice 100% compliance to safe medication practice 4.00 NA NA 4.00

Q- 80 % compliance to admission protocol 90 % compliance to admission protocol 4.00 NA NA 4.00

Percentage of charts sent to TQM in E- 80 % of charts are sent to TQM in an hour or

90 % charts were sent to TQM in an Hour or less NA 4.00 NA 4.00
less than 1 hour less
Sub-Total for Core Functions (40 %) 4.00
C. Support Functions: 30 %

Q-80 % compliance to daily chart content 70 % compliance to daily chart content checking using
4.00 NA NA 4.00
Percentage of number of charts checking using checklist checklist
returned from billing section with
incomplete requirements Q-80 % compliance to chart checking prior to 70 % compliance to chart checking prior to sending to
4.00 NA NA 4.00
sending to TQM using checklist TQM using checklist

Compliance to ARTA Provisions Q- 80% compliance to ARTA provision. 80% Complied to ARTA provision. 5.00 NA NA 5.00

Q- 80 % Compliance to 5S Checklist 70 % complied to 5S checklist 5.00 NA NA 5.00

Prevention of Hospital Acquired
Infection Q- Notice of Non- Compliance to ICC protocol complied to ICC protocol and guidelines with Zero
5.00 NA NA 5.00
and guidelines does not exceed 2/ month notice of non compliance

Sub-Total for Support Functions(30 %) 4.60

RATING
Total over all rating 4.48
Final Average Rating 4.48
Adjectival Rating very satisfactory
Comments and Recommendation for Development Purposes (Please do not leave this blank)

Discussed With: Assessed by: Date Final Rating by: Date

I certify that I discussed my assessment of the perfomance with the employee
December 30, December 30,
2020 Luz M. Chiong, RN, MAN 2020
Employee Supervisor Next Higher Supervisor
Legend: 1- Quality 2 -Efficiency 3 - Timeliness 4 - Average

ISO CERTIFIED HOSPITAL - QUALITY MANAGEMENT SYSTEM

This document is a property of Jose B. Lingad Memorial General Hospital and the content are treated confidential therefore, unauthorized reproduction is
strictly prohibited unless otherwise permitted by JBLMGH Top Management