Professional Documents
Culture Documents
To Be Completed by The Assessee
To Be Completed by The Assessee
Sl.No Score on a 1 to 10 scale (1-3 for poor, 4-6 for satisfactory, 7-9 for good
Activities and 10 for excellent.
Poor Satisfactory Good Excellent
(1-3)Marks (4-6)Marks (7-9)Marks (10)Marks
1 % Increase in total TB Notification
(Public+Private)
2 Treatement success rate of new TB Patients
(Publice+Private)
3 DBT of Nikshay Poshan Yojana of TB
Patients
4 Treatment Supporter Payment
5 % of Dignosis and Notified TB Patients
(DSTB & DRTB put on treatment )
6 Coordinates with all concerned to ensure
that all contacts of sputum positive patients
are screened for TB
7 Ensures retrieval of defaulters as per
schedule.
8 Real time Nikshay entry.
9 Assists DTO and MOTC in ensuring a
regular supply of drugs and other logistics
to all PHIs in the subdistrict. Retrieve
unfinished medicine boxes of
patients who have defaulted/died/transfer
out etc)..
1 Visits all patients at home before
registration and provide health education
and counseling to the patients and family.
11 No. of health facilities superviser by the TB
unit (Public+Private)
12 Attendance
Joining Date
Review Period
Place of Posting
Date of Completion of Contract:
Total leave taken during the year.
Did you take leave for more than 7 days at a
stretch? If yes, give purpose.
ASSESSMENT OF WORK
Sl.No Score on a 1 to 10 scale (1-3 for poor, 4-6 for satisfactory, 7-9 for good
Activities and 10 for excellent.
Poor Satisfactory Good Excellent
(1-3)Marks (4-6)Marks (7-9)Marks (10)Marks
1 U-DST of all Notified TB patients
2 End of IP and End of CP Follow up of all
TB Patients and entry of follow-up in
Nikshay
3 Prepares slides and recorded
results. Maintained the Laboratory
Register.
4 Coordinates with other staff to ensure
that patients with productive cough for
three weeks or more undergo sputum
examination and receive containers
and necessary instructions.
…………………………………………………………………………………………………………………………………… …..
…………………………………………………………………………………………………………………………………………
Joining Date
Review Period
Place of Posting
Date of Completion of Contract:
Details of Trainings Attended, Dates,
Duration, Venue and Organizing Institution
Total leave taken during the year.
Did you take leave for more than 7 days at a
stretch? If yes, give purpose.
ASSESSMENT OF WORK
Sl.No Score on a 1 to 10 scale (1-3 for poor, 4-6 for satisfactory, 7-9 for good
Activities and 10 for excellent.
Poor Satisfactory Good Excellent
(1-3)Marks (4-6)Marks (7-9)Marks (10)Marks
1 Number of case notified in complete year
2 Outcome assigned
3 collection of bank a/c no. of TB patients
for NPY.
4 Ensures regularity of Medicine (Daily
Regimen)
.
5 Ensures regular drugs supply for MDR
TB patients as per guidelines.
6 Verifies address of all new patients and
educate patients and their families on the
plan of treatment.
12 Attendance
Comments from MOTC:
…………………………………………………………………………………………………………………………………… …..
Comments from DTO:
…………………………………………………………………………………………………………………………………………
Comments from CMO:
PERFORMANCE APPRAISAL FORM
Data Entry Operator (NTEP)
To be completed by the Assessee
District
Name of Data Entry Operator
Joining Date
Place of posting
Review Period
Date of Completion of Contract:
Details of Trainings Attended, Dates,
Duration, Venue and Organizing
Institution
Total leave taken during the year.
Did you take leave for more than 7
days at a stretch? If yes, give
purpose.
ASSESSMENT OF WORK
…………………………………………………………………………………………………………………………
………………
…………………………………………………………………………………………………………………………
………………
PERFORMANCE APPRAISAL FORM
District PMDT & TBHIVCO-Ordinator (NTEP)
To be completed by the Assessee
District
Name of District PMDT &
TBHIVCO-Ordinator
Joining Date
Review Period
Date of Completion of Contract:
Details of Trainings Attended, Dates,
Duration, Venue and Organizing
Institution
Total leave taken during the year.
Did you take leave for more than 7
days at a stretch? If yes, give
purpose.
ASSESSMENT OF WORK
…………………………………………………………………………………………………………………………
………………
PERFORMANCE APPRAISAL FORM
Statistical Assistant (NTEP)
To be completed by the Assessee
District
Name of SA
Joining Date
Review Period
Place of Posting
Date of Completion of Contract:
Total leave taken during the year.
Did you take leave for more than
7 days at a stretch? If yes, give
purpose.
ASSESSMENT OF WORK
Joining Date
Review Period
Place of Posting
Date of Completion of Contract:
Total leave taken during the year.
Did you take leave for more than
7 days at a stretch? If yes, give
purpose.
ASSESSMENT OF WORK
Joining Date
Review Period
Place of Posting
Date of Completion of Contract:
Total leave taken during the year.
Did you take leave for more than
7 days at a stretch? If yes, give
purpose.
ASSESSMENT OF WORK
…………………………………………………………………………………………………………………………
………………
PERFORMANCE APPRAISAL FORM
Counsellor for DRTB Centre (NTEP)
To be completed by the Assessee
District
Name of Counsellor
Joining Date
Review Period
Place of Posting
Date of Completion of Contract:
Total leave taken during the year.
Did you take leave for more than
7 days at a stretch? If yes, give
purpose.
ASSESSMENT OF WORK
..........................................................................................................................................................................
.
PERFORMANCE APPRAISAL FORM
SMO for DRTB Centre (NTEP)
To be completed by the Assessee
District
Name of SMO
Joining Date
Review Period
Place of Posting
Date of Completion of Contract:
Total leave taken during the year.
Did you take leave for more than
7 days at a stretch? If yes, give
purpose.
ASSESSMENT OF WORK
..........................................................................................................................................................................
.....
PERFORMANCE APPRAISAL FORM
MO MEDICAL COLLEGE(NTEP)
To be completed by the Assessee
District
Name of MO
Joining Date
Review Period
Place of Posting
Date of Completion of Contract:
Total leave taken during the year.
Did you take leave for more than 7
days at a stretch? If yes, give
purpose.
ASSESSMENT OF WORK