Annex B

INDIVIDUAL PERFORMANCE COMMITMENT AND REVIEW (IPCR)

I, NAME/POSITION/DESIGNATION , of the __________PROVINCIAL GOVERNMENT OF QUEZON___________, Division of __________ _________________
OFFICE / HOSPITAL commit to deliver and agree to be rated on the attainment of the following targets in accordance with the
indicated measures for the period of ________________ to _______________, 20 _______

_______________________
Signature of Employee
______________________
Date

Reviewed by: Date Recommended by: Date Approved by: Date

Immediate Supervisor Office PMT Head Office

RA 5-Outstanding
TI
N 4-Very Satisfactory
G
3-Satisfactory
2-Unsatisfactory
1-Poor
MFO SUCCESS INDICATORS ACTUAL RATING
(Targets + Measures)
(Note: Please add rows if necessary). ACCOMPLISHMENTS REMARKS
(Note: Please add rows if necessary) Q E T A
Strategic Priority (20%):
Output 1
Output 2
Subtotal:
Core Function (70%):
Output 1
Output 2
Subtotal:
Support Function (10%):
Output 1
Output 2
Subtotal:
TOTAL RATING
FINAL RATING
ADJECTIVAL RATING
Comments and Recommendations for Development Purposes or Rewards/Promotion

Discussed with Date Assessed by Date Calibrated by Date Final Rating by Date
I certify that I discussed my
assessment of the performance with
the employee.
_____________________ ________________
Employee ______________________ Office PMT _______________________
Supervisor Head of Office
 the employee.
_____________________ ________________
Employee ______________________ Office PMT _______________________
Supervisor Head of Office