DOH - SPMS Form 3
INDIVIDUAL PERFORMANCE COMMITMENT AND REVIEW (IPCR)
I, John Vanne D. Samillano, RMT, of the Regional Office VI - DOH assigned at Maayon, Capiz, commit to deliver and
agree to be rated on the attainment of the following targets in accordance with the indicated measures for the period
January to June 2016.
JOHN VANNE D. SAMILLANO, RMT Date:
Approved By: Date
Joeffry M. Espiritu
Name of Supervisor
5 – Outstanding
4 – Very Satisfactory
3 – Satisfactory
2 - Unsatisfactory
1 - Poor
SUCCESS INDICATOR RATING
Remar
Output (Targets + Actual Accomplishment QTY QLY T
A (4) ks
Measure) (1) (2) (3)
100% of Pregnant women
85% of Pregnant women tested for
correctly tested for Hemoglobin
Hemoglobin and Hematocrit
and Hematocrit Determination,
Determination, Blood Typing,
Blood Typing, Urinalysis,
Urinalysis, Hepatitis B Surface
Hepatitis B Surface Antigen 4 4 5 4.33
Antigen Detection, Test for Syphilis
Detection, Test for Syphilis as
as ordered by MHO/PHN/RHM for
ordered by MHO/PHN/RHM for
their Health Assessment. Results
their Health Assessment.
released within 2 hours.
Results released within 1 hour.
100% of the actual clients
85% of the actual patients tested for
accurately tested for Urinalysis
Urinalysis as ordered by the MHO in
as ordered by the MHO in the
the facility for their Health
facility for their Health 4 4 5 4.33
Assessment. Results released
Assessment. Results released
within 2 hours upon arrival at the
within 1 hour upon arrival at the
facility.
facility.
95% of the actual clients tested for 100% of the actual clients
Complete Blood Count and Platelet accurately tested for CBC-APC
Count (CBC-APC) as ordered by the as requested by MHO in the
MHO in the facility for their Health facility for their Health 4 4 5 4.33
Assessment. Results released Assessment. Results served
Performs within 2 hours upon arrival at the within 1 hour upon arrival at the
laboratory facility. facility.
examinations
Performs
laboratory
examinations
100% of the actual clients
85% of the actual clients tested for
accurately tested for Fecalysis
Fecalysis as ordered by MHO in the
as ordered by MHO in the
facility for their Health Assessment 4 4 3 3.67
facility for their Health
served within 2 hours upon arrival at
Assessment served within 2
the facility.
hours upon arrival at the facility.
100% of the actual patients
75% of the actual patients tested for
tested for Random/Fasting
Random/Fasting Blood Sugar
Blood Sugar Measurement,
Measurement, Cholesterol
Cholesterol Measurement, Uric
Measurement, Uric Acid
Acid Measurement as ordered 4 4 5 4.33
Measurement as ordered by MHO
by MHO for basis of NCDs Risk
for basis of NCDs Risk Assessment
Assessment in the facility,
in the facility, Results served within
Results served within 1 hour
2 hours upon arrival at the facility.
upon arrival at the facility.
Assist and observe to the Senior
Efficiently assisted and
Medical Technologist on sputum
observed proper techniques on 3 4 3.50
smearing for symptomatic client as
smear preparation and staining.
need arises
Complete Narrative
Narrative Accomplishment Report Accomplishment Report on
on laboratory examinations done laboratory examinations done
3 4 3 3.33
every month. Report submitted with number of clients served
before the end of the month. every month. Report submitted
Prepares
before the end of the month.
analyses and
submit
reports
Assist the Senior Medical Efficiently assisted the Senior
Technologist in the preparation and Medical Technologist on the 3 4 _ 3.50
submission of reports. preparation of the reports.
Reflected accurate logbook
Reflected logbook based entries of
Daily Time based entries of 100% of
100% of working days within the 3 4 3 3.33
Records working days within the month
month concerned.
concerned.
Attendance to Reports to station within 8am-5pm Reports to station on time within
3 4 _ 3.5
Station as scheduled. 8am-5pm as scheduled.
Attended and actively
Attendance to Attendance to medical mission by
participated the Medical Mission
Medical the Capiznon sa Manila at Maayon 3 4 _ 3.5
in the Municipality on March 19,
Mission Municipal Hall as scheduled.
2016.
Maintained and ensured all
laboratory equipments are in
good working condition at all
Maintain
Maintenance of laboratory times. Inventory of supplies
laboratory
equipment, checking of supplies, done to check if the laboratory
facilities, 3 5 _ 4
and observe cleanliness in the has adequate resources to
supplies and
laboratory serve the client. Treated all
equipment
specimen as a potential hazard
and disinfected working tables
after the work is done.
Assistance to the Senior Medical
Efficiently assisted the Senior
Technologist and Public Health
Assist in RHU Medical Technologist and Public
Nurse for the PHILCAT 3 4 _ 3.5
Activities Health Nurse on preparations
Accreditation of the TB-DOTS
for the accreditation.
Facility
6 monthly meetings with
Meeting with 6 monthly meetings with DMO/MHO
DMO/MHO actively participated 3 4 3.50
DMO/MHO attended as scheduled.
and attended.
Total Overall Rating 52.67
Final Average Rating 3.51
Adjectival Rating Very Satisfactory
Comments and Recommendation for Development Purposes
Discussed
Assessed by: Date Final Rating by: Date
With:
I certify that I discussed my
assessment of the perfomance
with the employee
John Vanne
D. Samillano, Joeffry M. Espiritu
RMT
Elmer E. Bucayan, MD
Legend: 1- Quantity 2 -Quality 3 - Timeliness 4 - Average
