DOH
INDIVIDUAL PERFORMANCE COMMITMENT AND REVIEW (IPCR)
I, Saephan Marie S. Logrunio, of the Regional Office VI - DOH assigned at KABANKALAN, Negros Occidental, commit to delive
rated on the attainment of the following targets in accordance with the indicated measures for the period Jan to June, 2016.
Saephan Marie S. Logrunio, RN
Approved By:
ELIZABETH ALVAREZ, RN
Name of Supervisor
SUCCESS INDICATOR
Output
(Targets + Measure)
6 complete and accurate EPI Reports of
Reports 100% of Barangays assigned submitted
every 15th day of the month.
6 complete and accurate CHT Reports
per household of 100% of Barangays
assigned submitted every 15th day of the
month.
6 complete and accurate FP Reports of
100% of Barangays assigned submitted
every 15th day of the month
Reports on IMCI and Child Health
Nutrition submitted every 15th day of the
month.
Complete and accurate reports on CAS
and NSMP and submitted every 27th day
of the month
100% of target Clients for MNCHN
Services among NHTS - PR and non-
NHTS:Missed Children(MMR/ MCV2),
SWRA with Unmet Needs, Pregnant
Availability of Masterlist
Women and their Outcomes, and
Children who are stunted and wasted of
100% of Barangays assigned every 1st
working day of the following month
Date: _____
Date
5 – Outstan
4 – Very Sa
3 – Satisfac
2 - Unsatisf
1 - Poor
RATING
Actual Accomplishment QTY QLY T
(1) (2) (3)
Well-timed submission of six EPI
reports in my assigned barangay
every 15th day of the month- with 3 4 3
precison. Reports taken from monthly
reports of RHM submitted to the PHN.
Six accurate reports on CHT in my
catchment area with aide of CHT
parthers updated monthly with my
supervision and submitted every 15th
3 4 3
day of the month. Reports are
updated monthly by the CHT partners
by doing house to house visits, and
interviews.
Six precise FP reports relayed thru
email every 15th day of the month.
Reports based from TCL, M1 and 3 4 3
monthly updating of CHT partners
under my supervision.
IMCI and Child Health Nutrition
reports are gathered with precision
and submitted every 15th day of the
3 4 3
month for six months; validation done
with RHM based on TCL and M1
data.
Reports on CAS and NSMP of my
assigned barangays are gathered
timely and accurately. Reports are 3 4 3
conformed with RHM for validation
and consistency with M1 reports.
Masterlisting of MNCHN Services
amongst NHTS-PR and non-NHTS
such as missed children
(MMR/MCV2), SWRA with unmet
needs, Pregnant women and their
outcome, Stunted and wasted 4 4 3
children submitted on the 23rd day of
the month. Reports conformed form
the TCL, CHT reports and monthly
update and OPT reports gathered bi-
anually in my assigned barangay.
 RATING
SUCCESS INDICATOR
Output Actual Accomplishment QTY QLY T
(Targets + Measure)
(1) (2) (3)

Updates on monthly inventory of

Accurate and updated monthly inventory
of 100% of MNCHN logistics and supplies
including Updated Vaccine/ Syringes
Stock Card, FP Logistics Inventory Card/
Inventory of Supplies Logbook, and Updated Logbooks on Vit.
A, Ferrous Sulfate, ECCD Card/ Mother
and Child Book of 100% of Barangays
assigned submitted every 8th day of the
month.
MNCHN logistics and supplies
accurately accomplished consistently;
reports was submitted every first
working day of the month. Rreports
were verified by the midwife of my 4 4 3
catchment area and by the PHN.
Reports are gathered by manually
counting of contraceptive supplies,
and other supplies delivered by the
DOH.

Profiling of 100% of Non-NHTS

Profiling Household of assigned Barangay by end 4 4 4
year of 2015

LGU health services well-provided.

100% of LGU Health Services assisted
in term of client provided services,
LGU Health Service Assisted
improvement of health indicators and
other targets.
Programs of the LGU well
implemented. Able to assist the MHO
in Provision of available health
services and all programs from LGU.
3 3 3
Attends sessions of Sangguniang
Bayan for new health programs to be
implemented such as Blood Letting,
CIVAC, Tuli Mission and Medical
mission, etc.

Assisted RHM in collaboration with

the Barangay Council in the
Assist RHM in the creation and
development of Community Health
functionalization of barangay CHT and
Teams; attends meetings with the
Management Teams in 100% of
Barangay Captains for proper
CHT Barangays assigned within the month of 4 5 3
introduction of the CHT programs;
replacement( CHT Partner) and non-
Taking over my responsibility as
functionality ( CHT and Management
supervisors of the CHT partners and
Team)
clearly explained their roles in the
Holistic approach of CHT programs.

Inventory on FP logistics and survey

on reasons for non-availment of
MNCHN servies in my assigned
barangays was delivered and
Assist the PHN in the conduct of
submitted on time in a quarterly basis
inventory of FP logistics and survey on
by the PHN. Gathering of these
FP/MNCHN Implementation reasons for non-availment of MNCHN 4 4 3
reports done in collaboration with the
services in 100% of Barangays assigned
NDP and Midwife; assist RHM in
within the quarter prescribed
assessing new acceptors, follow up
new acceptors and assessing drop-
outs giving health teachings about
other possible methods.

SUCCESS INDICATOR
Output
(Targets + Measure)
Conduct of inventory of Personnel Skills
of 100% of Barangays assigned and
submitted every quarter
Assist in the 100% of conducted
preliminary reporting and investigation of
Maternal Death
Assist RHM during scheduled
EPI Implementation immunization in the assigned Barangay 1
hour upon arrival of the clients.
Assist in the referral of severly wasted thru OPT updating children identified
Nutrition Program
and stunted pre-school children within 48 as stunted and wasted are referred to
Implementation
hours
Training of BHW and CHT Partners on
TSISMIS of 100% Barangay Assigned
HI 5
Defaulters in EPI, Pre-Natal and Post-
Natal are well monitored. BHWs and
Track MNCHN defaulters such as EPI,
Prenatal and Postnatal clients of 100%
tapped whenever their members have
assigned barangay
Attendance in stations as Report from 8am to 5pm as scheduled
scheduled working stations assigned
Reflected correct and logbook entries of
Daily Time Records 100% of working days within the month
concerned
RATING
RATING
Actual Accomplishment QTY QLY T
(1) (2) (3)
Quarterly reports of Inventory of
Personnel Skills of my assigned
barangays were delivered and
submitted accurately; able to gather 4 4 3
and accomplish data by conducting
an interview to subjects (Midwives)
once every 4 months.
Maternal deaths highly monitored for
any cases; no maternal deaths
4 4 3
reported from my assigned
Barangays for six months.
EPI advocacy well-spread out.
Assisted RHM in vaccination and
recording; arrives in BHS an hour
4 4 4
before the arrival of clients.
Immuization done with proper
techniques observed.
Severely wasted and stunted pre-
schoolers are identified bi -anually
4 4 3
the LGU for masterlisting of children
targeted for Nutrition Program;
reports submitted on-time.
CHT partners and BHWs in my
assigned barangays were trained on
TSISMIS. Roles as Health care
4 4 4
providers were emphasized; oriented
them on the reports to be submitted
monthly.
CHT parters per catchment are
4 4 3
missed MNCHN services every
month.
Arrives early at work and works
beyond 5 pm if necessary. Assist
4 4 4
RHM if there are patients to be
catered even after time-out.
DTRs submitted with proper data
based on official logbooks provided.
4 4 4
Timely submission of DTRs with
validation of City Health Officer.
 RATING
SUCCESS INDICATOR
Output Actual Accomplishment QTY QLY T
(Targets + Measure)
(1) (2) (3)

Total Overall Rating

Final Average Rating
Adjectival Rating
Comments and Recommendation for Development Purposes
Discussed With: Assessed by: Date Final Rating by:
I certify that I discussed my assessment
of the perfomance with the employee
SAEPHAN MARIE S. LOGRUNIO

ELIZABETH ALVAREZ, RN MELINDA J. SANCHEZ, RN

Employee Supervisor Next Higher Supervisor

Legend: 1- Quantity 2 -Quality 3 - Timeliness 4 - Average

 DOH - SPMS Form 3
CR)

mmit to deliver and agree to be

une, 2016.

Date: _______________

Date

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

RATING
Remarks
A (4)

3.3333

3.3333

3.3333

3.3333

3.3333

3.6666
RATING
Remarks
A (4)

3.6666

4.000

3.000

Assisted RHM in
development of
4.0000 CHT and
Management
teams.

4.333
RATING
Remarks
A (4)

4.333

No maternal deaths
reported in my area
4.333
from January to
June 2016

4.000

4.333

4.000

4.333

4.000

4.000
RATING
Remarks
A (4)

Date