INDIVIDUAL PERFORMANCE COMMITMENT AND REVIEW FORM

Name of Employee: MA. KAREN G. BALUYOT

Name of Rater: FRANCIS C. ACEDERA

Position: TEACHER I

Position: TEACHER IN-CHARGE

Bureau/Center/Service/Division: NORTHERN SAMAR

Date of Review:

Rating Period: SY 2015 - 2016

TO BE FILLED IN DURING THE PLANNING

TO BE FILLED DURING THE

EVALUATION

MFOs
I ACCESS

KRAs

OBJECTIVES

TIMELINE

Weight

PERFORMANCE

ACTUAL

per KRA
10%

INDICATORS

RESULT

Teaching

0 Prepared daily

Learning

lesson plans

to March

plans had the

Process

including

2016

following: objective,

(30%)

appropriate,

subject matter,

adequate and

learning tasks,

updated

evaluation and

instructional

assignment

materials

4- Had 4 of the 5

June 2015

RATING
Q

Ave

SCORE

5 - All daily lesson

parts of lesson plan

3 - Had 3 of the 5
parts
2 - Had 2 of the 5
parts
1 had 1 of the 5
parts

1 Facilitated

June 2015

learning in class

to March

through functional

2016

lesson plans, daily

logs and

10%

5 The teacher
established challenging
and measurable goal/s
for student learning
that is aligned with the

innovative
teaching strategies
CMN

K -12 Curriculum
P a g e PAGE

\* MERGEFORMAT 11 of 11 pages

Guides with the use of

Name of Employee: MA. KAREN G. BALUYOT

Name of Rater: FRANCIS C. ACEDERA

Position: TEACHER I

Position: TEACHER IN-CHARGE

Bureau/Center/Service/Division: NORTHERN SAMAR

Date of Review:

Rating Period: SY 2015 - 2016

TO BE FILLED IN DURING THE PLANNING

TO BE FILLED DURING THE

EVALUATION

MFOs

KRAs

OBJECTIVES

TIMELINE

Weight
per KRA

PERFORMANCE
INDICATORS
innovative teaching

ACTUAL
RESULT

RATING
Q

Ave

SCORE

aids like Laptop & LCD

Projectors/LMs & TGs
4 The teacher
developed a
measurable goal for
student learning that
is aligned with the K
-12 Curriculum Guides
with the use of
innovative teaching
aids like Laptop &
LCD/LMs & TGs
Projectors
3 The teacher clearly
communicated a focus
for student learning
that is appropriate for
students and is aligned
with the K -12
Curriculum Guides.
2 The teacher did

not have a clear focus

for student learning.
Name of Employee: MA. KAREN G. BALUYOT

Name of Rater: FRANCIS C. ACEDERA

CMN

P a g e PAGE

\* MERGEFORMAT 11 of 11 pages

Position: TEACHER I

Position: TEACHER IN-CHARGE

Bureau/Center/Service/Division: NORTHERN SAMAR

Date of Review:

Rating Period: SY 2015 - 2016

TO BE FILLED IN DURING THE PLANNING

TO BE FILLED DURING THE

EVALUATION

MFOs

KRAs

OBJECTIVES

TIMELINE

Weight
per KRA

PERFORMANCE
INDICATORS

ACTUAL
RESULT

RATING
Q

Ave

SCORE

1 The teacher did not

have a clear focus for
student learning or the
objective is too general
to guide lesson
planning or the
objective is
inappropriate for
students.

2 Monitored the

June 2015

attendance of the

to March

students in the

2016

subject area

10%

5 Attendance
checking is
systematically carried
out daily, reasons for
absence/s were noted

taught

and follow-up was

made
4 Attendance
checking was
systematically carried
out daily and reasons
for absences were
noted
3 Attendance
checking was

Name of Employee: MA. KAREN G. BALUYOT

Name of Rater: FRANCIS C. ACEDERA

CMN

P a g e PAGE

\* MERGEFORMAT 11 of 11 pages

Position: TEACHER I

Position: TEACHER IN-CHARGE

Bureau/Center/Service/Division: NORTHERN SAMAR

Date of Review:

Rating Period: SY 2015 - 2016

TO BE FILLED IN DURING THE PLANNING

TO BE FILLED DURING THE

EVALUATION

MFOs

KRAs

OBJECTIVES

TIMELINE

Weight
per KRA

PERFORMANCE
INDICATORS
systematically

ACTUAL
RESULT

RATING
Q

Ave

SCORE

carried out daily

2 Attendance
checking was carried
out twice a week
1 Attendance
checking was carried
out once

II. QUALITY

Pupils

0 Monitored,

June 2015

10%

5 - Evidences showed

Outcomes

evaluated and

to March

that the teacher

(30%)

tracked pupils

2016

purposely plans

progress.

assessments and
varies assessment
choices to match the
different student
needs, abilities, and
learning styles. Class
record reflected the
basis of ratings in all
classes/subject areas
handled. Pupils
portfolio contained all
of their
accomplishments.
Remediation/enrich

CMN

P a g e PAGE

\* MERGEFORMAT 11 of 11 pages

Name of Employee: MA. KAREN G. BALUYOT

Name of Rater: FRANCIS C. ACEDERA

Position: TEACHER I

Position: TEACHER IN-CHARGE

Bureau/Center/Service/Division: NORTHERN SAMAR

Date of Review:

Rating Period: SY 2015 - 2016

TO BE FILLED IN DURING THE PLANNING

TO BE FILLED DURING THE

EVALUATION

MFOs

KRAs

OBJECTIVES

TIMELINE

Weight
per KRA

PERFORMANCE
INDICATORS
ment program was

ACTUAL
RESULT

RATING
Q

Ave

SCORE

offered to all pupils

who need it.
4 lacked 1 indicator
3 lacked 2 indicators
2 lacked 3 indicators
1 lacked 4 indicators

5 Remedial
instruction was offered
to 100% of the total
1 Conducted

June 2015

remedial

to March

instruction to nonreaders twice a

week for

2016

10%

non-readers
4 Remedial
instruction was offered
to 85% - 99% of the
total non- readers
3 Remedial

intermediate
grades/daily for
primary grades

instruction was offered

to 70% - 84% of the
total non-readers
2 Remedial

Name of Employee: MA. KAREN G. BALUYOT

Name of Rater: FRANCIS C. ACEDERA

Position: TEACHER I

Position: TEACHER IN-CHARGE

Bureau/Center/Service/Division: NORTHERN SAMAR

Date of Review:

CMN

P a g e PAGE

\* MERGEFORMAT 11 of 11 pages

Rating Period: SY 2015 - 2016

TO BE FILLED IN DURING THE PLANNING

TO BE FILLED DURING THE

EVALUATION

MFOs

KRAs

OBJECTIVES

TIMELINE

Weight

PERFORMANCE

ACTUAL

per KRA

INDICATORS
instruction was offered

RESULT

RATING
Q

Ave

SCORE

to 55% - 69% of the

total non-readers
1 Remedial
instruction was offered
to 54% and below of
the total non-readers

5 Has updated SF 1,
2 Maintained an

June 2015

updated

10%

to March

records/ school

SF 2, Form 137E,
Form 138, Class
Record.

2016

4 lacked 1 indicator

forms

3 lacked 2 indicators
2 lacked 2 indicators
1 lacked 4 indicators.

III.

Community

GOVERNANCE

Involvement

of pupils

to March

15%

needing

2016

0 Visited parents

June 2015

5%

5 Visited parents four

times during the
school year.

academic

4 Visited parents
thrice during the

Name of Employee: MA. KAREN G. BALUYOT

Name of Rater: FRANCIS C. ACEDERA

Position: TEACHER I

Position: TEACHER IN-CHARGE

Bureau/Center/Service/Division: NORTHERN SAMAR

Date of Review:

Rating Period: SY 2015 - 2016

TO BE FILLED IN DURING THE PLANNING

TO BE FILLED DURING THE

EVALUATION

MFOs

KRAs

OBJECTIVES
CMN

TIMELINE

Weight

PERFORMANCE

ACTUAL

RATING
P a g e PAGE

\* MERGEFORMAT 11 of 11 pages

monitoring /

per KRA

INDICATORS
school year.

follow up of

3 - Visited parents

pupils at risk of

twice during the school

dropping out

year.

RESULT

Ave

SCORE

2 - Visited parents
once during the school
year.
1 - No parent visited
during the school year.

1 Participated in

June 2015

events/activities

to March

conducted in the

2016

5%

5 Participated in 4
or more
events/activities.
4 Participated in 3

community

events/activities.
3 Participated in 2
events/activities.
2 Participated in 1
event/activity.
1 No event/activity
attended.

2 Conducted

June 2015

regular/ 4

to March

periodic PTA

2016

5%
5 meeting conducted
with 100% of planned
accomplishments/

Name of Employee: MA. KAREN G. BALUYOT

Name of Rater: FRANCIS C. ACEDERA

Position: TEACHER I

Position: TEACHER IN-CHARGE

Bureau/Center/Service/Division: NORTHERN SAMAR

Date of Review:

Rating Period: SY 2015 - 2016

TO BE FILLED IN DURING THE PLANNING
CMN

TO BE FILLED DURING THE

P a g e PAGE

\* MERGEFORMAT 11 of 11 pages

EVALUATION
MFOs

KRAs

OBJECTIVES

TIMELINE

Weight
per KRA

PERFORMANCE

meetings/conferenc

INDICATORS
agreements met

es

4 meeting conducted

ACTUAL
RESULT

RATING
Q

Ave

SCORE

with 85-99% of
planned
accomplishments/agre
ements met
3 meeting conducted
with 70-84% of
planned
accomplishments/agre
ements met
2 meeting conducted
with 55-69% of
planned
accomplishments/
agreements met
1 meeting conducted
with 54% and below of
planned
accomplishments/agre
Professional

0 Participated in

Growth and

activities such as

Development

teachers

(15%)

June 2015

association, and
other
professional
organizations.

5%

ements met.
5 Participated in 5

to March

school activities.

2016

4 Participated 4
school activities.
3 Participated 3
school activities.
2 Participated 2

Name of Employee: MA. KAREN G. BALUYOT

Name of Rater: FRANCIS C. ACEDERA

Position: TEACHER I

Position: TEACHER IN-CHARGE

Bureau/Center/Service/Division: NORTHERN SAMAR

Date of Review:

CMN

P a g e PAGE

\* MERGEFORMAT 11 of 11 pages

Rating Period: SY 2015 - 2016

TO BE FILLED IN DURING THE PLANNING

TO BE FILLED DURING THE

EVALUATION

MFOs

KRAs

OBJECTIVES

TIMELINE

Weight
per KRA

PERFORMANCE
INDICATORS
school activities.

ACTUAL
RESULT

RATING
Q

Ave

SCORE

1 Participated 1
school activities.
1 Attended
seminars/ SLAC

June 2015

5%

to March

Session/

LAC Session/ meeting

2016

meeting in

5 Attend 5 seminars/
in school, district,
division etc., with

school, district,

proper documentation.

division etc.

4 Attend 4 seminars/
LAC Session/ meeting
in school, district,
division etc., with
proper documentation.
3 Attend 3 seminars/
LAC Session/ meeting
in school, district,
division etc., with
proper documentation.
2 Attend 2 seminars/
LAC

Name of Employee: MA. KAREN G. BALUYOT

Name of Rater: FRANCIS C. ACEDERA

Position: TEACHER I

Position: TEACHER IN-CHARGE

Bureau/Center/Service/Division: NORTHERN SAMAR

Date of Review:

Rating Period: SY 2015 - 2016

TO BE FILLED IN DURING THE PLANNING

TO BE FILLED DURING THE

EVALUATION

MFOs

KRAs

OBJECTIVES
CMN

TIMELINE

Weight

PERFORMANCE

ACTUAL

RATING
P a g e PAGE

\* MERGEFORMAT 11 of 11 pages

per KRA

INDICATORS
Session/ meeting in

RESULT

Ave

SCORE

school, district,
division etc., with
proper documentation.
1 Attend 1 seminar/
LAC Session/ meeting
in school, district,
division etc., with
proper documentation.

5 Attended 5 day
INSETS on ICT
2 Attended

June 2015

seminar/training

5%

to March

on ICT

4 Attended 4 day
INSETS on ICT
3 Attended 3 day

2016

INSETS on ICT
2 Attended 2 day
INSETS on ICT
1 Attended 1 day
INSETS on ICT
10%

IV PLUS
FACTOR
Name of Employee: MA. KAREN G. BALUYOT

Name of Rater: FRANCIS C. ACEDERA

Position: TEACHER I

Position: TEACHER IN-CHARGE

Bureau/Center/Service/Division: NORTHERN SAMAR

Date of Review:

Rating Period: SY 2015 - 2016

TO BE FILLED IN DURING THE PLANNING

TO BE FILLED DURING THE

EVALUATION

MFOs

KRAs

OBJECTIVES

CMN

TIMELINE

Weight

PERFORMANCE

ACTUAL

RATING
P a g e PAGE

\* MERGEFORMAT 11 of 11 pages

per KRA

INDICATORS

RESULT

Ave

SCORE

OVERALL
RATING
FOR ACCOMPLISHMENT

MA. KAREN G. BALUYOT

Ratee

FRANCIS C. ACEDERA
Rater
APROVED BY:
SILVANO S. PINCA
Principal In-Charge

CMN

P a g e PAGE

\* MERGEFORMAT 11 of 11 pages