DOH - SPMS Form 3

INDIVIDUAL PERFORMANCE COMMITMENT AND REVIEW (IPCR)
I, CRISTIAN PATRICK DC. EUSEBIO, of the CAGAYAN VALLEY MEDICAL CENTER, commit to deliver and agree to be rated on the attainment of the following targets in accordance with the
indicated measures for the period JULY to DECEMBER, 2022
Name of Employee: CRISTIAN PATRICK DC. EUSEBIO Date: 07-11-2022
Approved By: MARYGAY B. REY,RN,MSN Date: 07-11-2022
 Name of Supervisor    
  5 – Outstanding
4 – Very Satisfactory
3 – Satisfactory
2 - Unsatisfactory
1 - Poor

Success indicator RATING

Output Actual Accomplishment Q E T A Remarks
(Target + Measure)
(1) (2) (3) (4)
100% excellently performs assigned procedures within the specified time CORE
100% comprehensively assists in the promotion of health education to patients and their
family
CORE
Ensures effective and efficient response to all patient’s concerns and needs within the
specified time
CORE
95% of medical/ surgical supplies and equipment for every procedure are efficiently and
Better Health effectively prepared within the specified time CORE
Outcome Better
All ancillary requests, prescriptions and patients’ medical records are forwarded to CORE
Health Outcome s designated sections immediately upon availability of the needed document/ specimen
100% satisfactorily assists in maintaining inventory of supplies, functionality of equipment
and facilities regularly
CORE
All patients/cadavers are safely transported within 5 minutes upon notice CORE
All oxygen were properly and accurately installed within 1-2 minutes upon notice CORE
Maintains cleanliness and orderliness on all area of assignment throughout the shift CORE
Human Resource
All general assemblies, unit meetings, seminars, trainings and other hospital activities are
Training & Development attended with no tardiness recorded
CORE
Services
RATING
Total Overall Rating            
Final Average Rating                  
Adjectival Rating                     
Comments and Recommendation for Development Purposes
Discussed With: Assessed by: Date Final Rating by: Date
I certify that I discussed my assessment of the performance with the employee

CRISTIAN PATRICK DC. EUSEBIO MARYGAY B. RAY,RN,MSN 7-11-2022

07-11-2022
ANGELINE S. ARESTA, RN
Employee Supervisor Next Higher Supervisor
Legend: 1- Quality 2 -Efficiency 3 - Timeliness 4 - Average