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PERFORMANCE EVALUATION FORM

For the rating period July to December , 2013


EMPLOYEE : MICHELLE G. OLIMBA

OFFICE/DIVISION: OFFICE OF THE REGIONAL DIRECTOR (STO)

POSITION : Planning Assistant


PART I : PERFORMANCE (70%)
Weight
Alloc.
Work-KRA/Activity
(%)
20% 1. ME3-CHD Scorecard
5% 1.1. Prepares Analysis of CHD Scorecard report

UNIT

5%

1.2. Presents CHD Scorecard report with analysis


(thru various means, i.e., Mancom, RICT and PIRs)

10% 1.3. Prepares /coordinates all the required validation


tools from concerned program managers
20% 2. ME3-LGU Scorecard
10% 2.1Prepares Regional CY 2012 LGU Scorecard Report
based on DILG-LGPMS Report by Province.
5%

2.2Prepares analysis of 2012 LGU SC Report..

5%

2.3 Disseminates / Provides feedback re: LGU SC


report (thru RICT, Health Summits, etc.)

60% 3. Acts as Planning Assistant


10% 3.1 Assists in the conduct of Agency Performance
Reviews (APRs)
10% 3.2 Assists in the preparation of APR quarterly reports

5%

3.3Assists in the preparation of BUB

Unit of Measure /
Indicator

QN-# of analysis
QL-% acceptability
T- # of days / analysis
QN-# of reports presented
QL-% completeness / accuracy
T-as scheduled
QN-# of validation tools collected
QL-% completeness / accuracy
T- # of days / tool
QN-# of LGU Scorecard report
QL-% acceptability
T- # of days / report
QN-# of analysis
QL-% acceptability
T- # of days / analysis
QN-# of feesback provided
QL-% completeness / accuracy
T- as scheduled
QN-# of APR Assisted
QL-% acceptability
T-# of days/ review
QN-# of reports prepared
QL-% acceptability
T-# of days/ report
QN-# of reports prepared

QUANTITY (QN)
Targets

: Planning Unit

QUALITY (QL)

Accomp. Targets Accomp.

TIME (T)

RATING

Targets

Accomp.

QN

SUPERVISOR
QL
T
APS

EPS

QN

EMPLOYEE
QL
T APS

90%

97%

3 days/
analysis

2 days/
analysis

10

8.33

0.42

10

8.33

90%

97%

as scheduled

as scheduled

10

9.50

0.48

10

9.50

All

All

90%

97%

1 week

2 days

10

9.50

0.95

10

9.50

1 reg'l. report
2
90%
98%
(including LGU report in SLA)

2 weeks

3 days

10

10

9.67

0.97

10

10

9.67

10

9.00

0.45

10

10

9.67

10.00 0.50

90%

97%

1 week

1 day

ANA

90%

98%

as scheduled

as scheduled

10

90%

98%

July 23-25

July 23-25, Oct.16

10

10

10

10.00 1.00

10

10

10

9.67

90%

98%

10

9.00

0.90

10

10

8.67

90%

97%

2nd week of July 2nd week of July 8


& October 2nd week October
4th week November
4th week of July 4th week of July
6

7.50

0.38

7.00

9.50

Weight
Alloc.
(%)

Unit of Measure /
Indicator

Work-KRA/Activity
Progress Report.

5%

QUANTITY (QN)
Targets

QUALITY (QL)

TIME (T)

Accomp. Targets Accomp.

QL-% acceptability
T-# of days/ report

3.4 Assists in the monitoring of ETS.

QN- # of plans monitored

Targets

Accomp.

& October

& October

90%

97%

All

All

90%

98%

3rd week Sept.

As they come

75

90%

99%

As they come

31

90%

98%

RATING
QN

SUPERVISOR
QL
T
APS

EPS

QN

7.50

0.38

1st week August

10

9.50

0.95

July-December

July-December

10

10.00 1.00

July-December

July-December

9.00

end of each month end of each month

EMPLOYEE
QL
T APS

7.50

10

9.50

10

10.00

9.00

QL-% completeness / accuracy

T-# of days/ report


10% 3.5 Prepares documents for budget hearing
(for 2014 Budget Proposal)

QN- # of documents prepared


QL-% completeness/acceptability

T-# of days/ document


10% 3.6 Performs other function as may assigned by immediate
supervisor & ARD (i.e., preparation of communications,
memoranda, etc.)
10% 3.7 Attends to various seminars, meetings, workshops
(relative to ME3 & Planning)
100%

QN- #of memo/comm. Prepared

QL-% acceptable feedback


T- as needed
QN- #of trgs. Attended

QL-% acceptable feedback


T- as scheduled
Total Equivalent Point Score (EPS)
Multiply by Percentage Weight Allocation (70%)
Weighted Average Score (WAS)

DISCUSS AND AGREE ON THE ABOVE TARGETS :

DENICE U. PAGUIRIGAN, MPP.


Rater

0.90

MICHELLE G. OLIMBA,RN.
Ratee

12-Dec-13
Date

Legend
QN
QL
T
APS
EPS

:
-

PERC Action:
Quantity
Quality
Time
Ave. Point Score
Equivalent Point Score

9.26
6.48

E EVALUATION FORM
July to December , 2013

RATING
EMPLOYEE
EPS
0.42

0.48

0.95

0.97

0.48

0.48

0.97

0.87

0.35

RATING
EMPLOYEE
EPS

0.38

0.95

1.00

0.90

9.20
6.44

PART II. CRITICAL FACTORS (30%)


Behavioral Factors

Self Rating (10%)

1. COURTESY
2. HUMAN RELATIONS
3. INTEGRITY
4. STRESS TOLERANCE
5. INITIATIVE / RESOURCEFULLNESS
6. COMPLIANCE TO OFFICE RULES AND REGULATIONS
7. PUNCTUALITY AND ATTENDANCE
8. LEADERSHIP ( for supervisors only )
9. JUDGEMENT / DECISION MAKING ( for supervisors only )
Total Point Score
Divide by number of entries
Average Point Score (APS)
COMMENTS AND RECOMMENDATIONS BY THE IMMEDIATE SUPERVISOR
Strong Point

RATER

Supervisor Rater
Self - Rater
Subordinate
Peer Rater
Total Weighted Average Score (TWAS)
Total Weighted Average Score (TWAS) (Part I)
Total Overall Score (TWAS Part I + TWAS Part II)
Add : Intervening Task ( If any )
Final Numerical Rating
Adjectival Rating

DENICE U. PAGUIRIGAN, MPP.


Planning Officer III
Rater
PERC Action (Please encircle) Approval / Disapproval

Supervisor Rating (70%)

10
10
10
10
10
10
8

10
10
10
10
10
10
8

68
7
9.71

68
7
9.71

Subordinate Rating (10%)


S1

S2

Weak Point

Weighted Ave.
Score (WAS)
(Part I)
6.48
6.44
-

Peer Rating (10%)

Total (Sub)

P1
10
10
10
10
10
10
10

P2
10
10
10
10
10
10
10

P3
10
10
10
10
10
10
10

70
7
10.00

70
7
10.00

70
7
10.00

30.00
30.00
30.00
30.00
30.00
30.00
30.00
0.00
0.00
210.00
21
10.00

Recommendations

SUMMARY OF RATINGS
Percentage Weight Allocation
Total Weighted
With
Without
Ave.Score (TWAS)
Subordinate
Subordinate
(Part I)
65%
4.21
35%
2.25
-

Weighted Ave.
Score (WAS)
(Part II)
9.71
9.71
0.00
10.00

Percentage Weight Allocation

With
Without
Subordinate Subordinate
70%
15%
15%

6.47
6.47
9.39

Total (Peers)

Total Weighted Average Score (TWAS) x 30% (Part II)

Total Weighted Ave.


Score (TWAS)
(Part II)
6.80
1.46
1.50
9.75
9.75 X 0.30 =

Very Satisfactory

MICHELLE G. OLIMBA, R.N.


Planning Assistant
Ratee

CORAZON I. FLORES, MD.,MPH, CESE


OIC- Director III
Confirm by Next Higher

Dec. 12, 2013


Date

Supervisor
PERC Chairman

2.93

PERFORMANCE EVALUATION FORM


For the rating period JULY to DECEMBER, 2015
EMPLOYEE : CHARLYN R. FERNANDEZ, RN

PROVINCE

: RIZAL

POSITION : RAIDERS
RAIDERS
PART I : PERFORMANCE (70%)
Weight
Unit of Measure /
Alloc.
Work-KRA/Activity
Indicator
(%)
A. Assists in the implementation of various health programs of the Local Gov't Unit in accordance with the
program goals and objectives of the DOH and the health sector
QN-# of ANC defaulters tracked
20%
A.1 Track ANC defaulters
QL-% effectivity
T- w/in 6 months

MUNICIPALITY

: CAINTA

20%

A.2 Track clients for postpartum care

QN-# of post-natal defaulters tracked


QL-% effectivity
T- w/in 6 months

20%

A. 3 Track EPI defaulters

QN-# of EPI defaulters tracked:


a. 0-11 months
b. 12-23 months
c. 24-59 months
QL-% of effectivity
T- w/in 6 months

20%

A. 4 Conduct Health Program Education / Advocacy


(Breastfeeding, Family Planning, Newborn screening, micronutrient QN-# of Health Education/Advocacy Conducted
supplementation)

QUANTITY (QN)

QUALITY (QL)

TIME (T)

RATING
QN

SUPERVISOR
QL
T
APS

EPS

QN

QL

EMPLOYEE
T APS

Targets

Accomp.

Targets

Accomp.

Targets

Accomp.

100

203

95%

100%

10

10

8.67

1.73

10

10

8.67

1.73

60

85

95%

100%

10

8.00

1.60

10

8.00

1.60

120
200
200

158
285
399

95%
95%
90%

100%
100%
100%

6
6
6

6
6
6

10
10
10

10
10
10

6
6
6

8.67
8.67
8.67

10
10
10

10
10
10

6
6
6

8.67
8.67
8.67

8.67

1.73

1.60

685

1083

90%

100%

10

8.00

600

787

95%

100%

10

10

50

74

90%

100%

10

EPS

8.67

1.73

1.60

10

8.00

8.67

10

10

8.67

8.00

10

8.00

QL-% effectivity
T- w/in 6 months
A.5 Perform other related functions as may be assigned
A.5.1 Immunization services
20%
A.5.2 Track deworming defaulters

QN-# of vaccinated children


QL-% effectiveness
T- w/in 6 months
QN-# of deworming defaulters tracked
QL-% effectiveness
T- w/in 6 months

8.33

1.67

8.33

1.67

100%
Total Equivalent Point Score (EPS)
Multiply by Percentage Weight Allocation (70%)
Weighted Average Score (WAS)
DISCUSS AND AGREE ON THE ABOVE TARGETS :

ROSIE R. JAVIER, RN, MPA


Rater

CHARLYN R. FERNANDEZ, RN
Ratee

29-Dec-15
Date

Legend
QN
QL
T
APS
EPS

PERC Action:
-

Quantity
Quality
Time
Ave. Point Score
Equivalent Point Score

8.33

8.33

5.83

5.83

PART II. CRITICAL FACTORS (30%)


Behavioral Factors

Self Rating (10%)

1. COURTESY
2. HUMAN RELATIONS
3. INTEGRITY
4. STRESS TOLERANCE
5. INITIATIVE / RESOURCEFULLNESS
6. COMPLIANCE TO OFFICE RULES AND REGULATIONS
7. PUNCTUALITY AND ATTENDANCE
8. LEADERSHIP ( for supervisors only )
9. JUDGEMENT / DECISION MAKING ( for supervisors only )
Total Point Score
Divide by number of entries
Average Point Score (APS)
COMMENTS AND RECOMMENDATIONS BY THE IMMEDIATE SUPERVISOR
Strong Point

Subordinate Rating (10%)

Supervisor Rating (70%)

10
10
10
8
8
10
8

S1

10
10
10
8
8
8
8
8
8
78
9
8.66

64
7
9.14

S2

Weak Point

Total (Sub)

Peer Rating (10%)


P1
10
10
10
10
8
10
8

P2

P3

Total (Peers)

10.00
10.00
10.00
10.00
8.00
10.00
8.00

66
7
9.43

66.00
7
9.43

Recommendations

SUMMARY OF RATINGS
RATER

Supervisor Rater
Self - Rater
Subordinate
Peer Rater
Total Weighted Average Score (TWAS)
Total Weighted Average Score (TWAS) (Part I)
Total Overall Score (TWAS Part I + TWAS Part II)
Add : Intervening Task ( If any )
Final Numerical Rating
Adjectival Rating

Weighted Ave.

Percentage Weight Allocation

Weighted Ave.

Percentage Weight Allocation

Total Weighted Ave.

Score (WAS)

With

Without

Ave.Score (TWAS)

Score (WAS)

With

Without

Score (TWAS)

(Part I)

Subordinate

Subordinate

(Part I)

(Part II)

Subordinate

Subordinate

(Part II)

5.83
5.83
-

60%
30%
10%

65%
35%
-

3.79
2.04
-

8.66
9.14
0.00
9.43

70%
10%
10%
10%

70%
15%
15%

6.06
1.37
1.41
8.84

5.83
5.83
8.48

Total Weighted Average Score (TWAS) x 30% (Part II)

2.65

8.00
Very Satisfactory

ROSIE R. JAVIER, RN, MPA

CHARLYN R. FERNANDEZ, RN

Rater

Ratee

PERC Action (Please encircle) Approval / Disapproval

Total Weighted

29-Dec-15
Confirm by Next Higher

Date

Supervisor
PERC Chairman

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