INDIVIDUAL PERFORMANCE COMMITMENT AND REVIEW FORM (IPCRF)

Name of Employee : DIANA KRISTINE E. GUTEZA RN, MAN Name of Rater DAVID M. NUAY
Position: NURSE II Position CHIEF EPS, SGOD
Review Period: JANUARY- DECEMBER 2018 Date of Review
Bureau/Center/Service/Division : DepEd BATANGAS

TO BE FILLED IN DURING PLANNING TO BE FILLED IN

PERFORMANCE INDICATORS RATING
WEIGHT
MFOs

KRAs

OBJECTIVES MOVs TIMELINE PER ACTUAL RESULTS

KRA (QUALITY, EFFICIENCY, TIMELINESS) Q E

5- Perform health assessment, treatment and referral(Q) of

at least 500 learners (E) 5 days before the end of each
NUtrition Programs and Services

month (T)
4- Perform
health assessment, and treatment (Q) of 400-499
learners(E) 4 days before the end of each month (T) Q-Performed health
assessment and
Perform health inspection, treatmentand referral to an
January-
(30%)

assessment, treatment and referral Certificate of appearance, list of December 10% 3-Perform health
1 of at least 500 learners within a learners assessed, pictures E- Average of 399 learners 5 3
2018 assessment (Q) of 300-399 learners (E) 3 days before the
month end of each month (T) every month
T-4 days before the end of
2- Conduct interview in (Q) of 200- each month
BASIC EDUCATION SERVICES

399 learners(E) 2 days before the end of each month (T)

1-Scheduled health assessment

of learners before the end of each month
5- Provide health teaching sessions about the 8 identified
NUtrition Programs and Services (30%)

topics (Q to all assigned schools (E) eight weeks before the

Provide health teaching sessions of
the 8 identified topics to all assigned
2 December
senior and junior HS before the end
of the school year
Certificate of appearance,
pictorial report
end of the school year (T)
4-
Provide health teaching sessions about the 6-7 identified
topics (Q to 86-99%of the assigned schools (E) seven weeks Q-Provided healtn
before the end of the school year (T) symposiums about 6
identified topics (Deworming,
January- WIFA, Rabies, ARH and NDEP)
10% 3- Provide health teaching 4 5
2018 E- to all
sessions about the4-5 identified topics (Q to 76-85%of the assigned schools
assigned schools (E) six weeks before the end of the school T-six weeks before the
year (T) end of the school year
2- Provide health teaching sessions
about the 2-3 identified topics (Q to 66-75%of the assigned
schools (E) five weeks before the end of the school year (T)

1-Provide health teaching

sessions about the 1 identified topic (Q to 50-65%of the
assigned schools (E) a month before the end of the school
year (T)

DEPEDBATS-ODS-F-004/R0/06-01-2018 Page 1 of 14

NUtrition Programs and Services (30%)
BASIC EDUCATION SERVICES
Conduct health assessment,
interview,treatment and referral of
Certificate of appearance,
3 all teaching and non teaching
personnel of the assigned schools
before the end of the school year
HEALTH PROGRAMS AND SERVICES (30%)
BASIC EDUCATION SERVICES
100 % of the assigned schools were
monitored and visited every month
to evaluate the implementation of
1 Narrative report per District
WinS Program before the submission
on the Online Monitoring System
DEPEDBATS-ODS-F-004/R0/06-01-2018
5- Conduct health assessment, interview, treatment and
referral(Q) of all the teaching and non teaching personnel of
the assigned schools (E) 6 weeks before the end of the
school year (T)
4- Conduct health assessment,
interview, and treatment (Q) of 86-99% the teaching and
non teaching personnel of the assigned schools (E) 5 weeks
before the end of the school year (T)
Q- Conduct health
assessment, interview,
January- 3-Conduct health assessment and interview (Q) treatment and referral
of 76-85% the teaching and non teaching personnel of the E-100%the teaching
pictorial report December 10% and non teaching personnel 5 5
2018 assigned schools (E) 4 weeks before the end of the school
year (T) of the assigned schools
T- 4 weeks before the end of
2-Conduct interview (Q) of 66-75% the teaching and the school year
non teaching personnel of the assigned schools (E) 3 weeks
before the end of the school year (T)
1-Set a schedule for health assessment (Q)of 50-65% of the
teaching and non teaching personnel of the assigned schools
(E) 2 weeks before the end of the school year(T)
Sub - Total
5-All the assigned Schools were monitored and visited every
month to evaluate the the implementation of WinS Program
5 weeks before the submission on the Online Monitoring
System
4- 85-99% of the assigned Schools were
monitored and visited once every two months to evaluate
the implementation of WinS Program 4 weeks before the
submission on the Online Monitoring System
3- 70-
84% of the assigned Schools were monitored and visited
once every quarter to evaluate the implementation of WinS Q-All the assigned Schools
Program 3 weeks before the submission on the Online were monitored and visited
Monitoring System 2-55-60% of E-
January-
December the assigned Schools were monitored and visited once every every 2 months T-
10% 3 weeks before the 5 4
2018 6 months to evaluate the implementation of WinS Program
2 weeks before the submission on the Online Monitoring submission on the Online
System Monitoring System
1-54% and
below of the assigned Schools were monitored and visited
once every year to evaluate the implementation of WinS
Program 1 week before the submission on the Online
Monitoring System
Page 2 of 14

HEALTH PROGRAMS AND SERVICES (30%)
BASIC EDUCATION SERVICES
Conduct deworming sessions to all
assigned schools to achieve the 85%
2 target within the month of
implementation
HEALTH PROGRAMS AND SERVICES (30%)
BASIC EDUCATION SERVICES
All the assigned schools in Area I, II
and IV were assisted in setting up a
3 school clinic with complete
functional facility before the end of
the year
DEPEDBATS-ODS-F-004/R0/06-01-2018
Deworming reports/ pictorial
Pictorial and narrative report.
5- Conduct deworming sessions to all (100%) assigned
schools (E) and achieve 85% and up of the target (Q) within
the month of implementation (T)
4.Conduct deworming sessions to 86-99% of the assigned
schools (E) and achieve 70-84% and up of the target (Q) a
week after the month of implementation (T)
3-Conduct deworming sessions to 76-85% of the assigned Q-Conduct deworming
schools (E) and achieve 55-69% and up of the target (Q) 2 sessions to 12/12 of the
January- weeks after the month of implementation (T) assigned schools
December E-and achieve an average of
10% 5 4
2018 83.67% of the target
T- a week after
2-Conduct deworming sessions to
66-75% of the assigned schools (E) and achieve 40-54% and the month of implementation
up of the target (Q) 3 weeks after the month of
implementation (T)
1-Conduct deworming
sessions to 50-65% of the assigned schools (E) and achieve
0-39% and up of the target (Q) a month after the
implementation (T)
5. All the assigned Junior and Senior HS in Area I. II and IV
were assisted in setting up a functional school clinic with
complete facilities (Weighing Scale, BP App, Stetoscope,
Cabinets, Bed, Medicines, IEC Materials, health forms) 2
months before the end of the year
4. 11-12 of the assigned
Junior and Senior HS in Area I, II and IV were assisted in
setting up a functional school clinic with partially (lacks only
1 of the listed facility)complete facilities a month before the
end of the year
3. 8-10 of the assigned Junior and Senior HS in
Area I, II and IV were assisted in setting up a functional Q- 11 of the assigned schools
school clinic with minimal(lacks 2-3 of the listed facility) in Area I, II and IV were
facilities 3 weeks before the end of the year assisted in setting up a
January
functional school clinic
-December 10% 2. 5-7 of the assigned Junior and Senior HS in Area I, II 4 4
2018 E- with partial
and IV were assisted in setting up a functional school clinic completeness of facilities
with very minimal minimal(lacks 4-5 of the listed facility) T-a month
facilities 2 weeks before the end of the year before the end of the year
1-1-4 of the assigned Junior and Senior HS in Area I, II and
IV were assisted in setting up a functional school clinic but
lack 6 or more of the listed facility a week before the end of
the year
Sub - Total
Page 3 of 14

BASIC EDUCATION SERVICES
100% of the assigned schools (E)
LINKAGES (20%)
were able to establish an active
partnership among the PTA's, LGU's
and other stakeholders to initiate at
1 December
least 4 projects (Q) to sustain health
and nutrition programs like WASH in
Schools 5 weeks before the end of
school year (T)
BASIC EDUCATION SERVICES
LINKAGES (20%)
Strengthen the advocacy campaign in
Blood Donation among all districts to
2 Narrative report per District
gather a minimum of 250 bags
before the end of the year
DEPEDBATS-ODS-F-004/R0/06-01-2018
Copies of pictures, Narrative
reports
-December
5. 100% of the assigned schools were able to establish an
active partnership among the PTA's, LGU's and other
stakeholders to initiate at least 4 projects to sustain health
and nutrition programs like WASH in Schools 5 weeks before
the end of school year
4- 85%-
99% of the assigned schools were able to establish an active
partnership among the PTA's, LGU's and other stakeholders
to initiate at least 3 projects to sustain health and nutrition
programs like WASH in Schools 4 weeks before the end of Q-10 out of 12 schools were
school year able to established an active
3- partnership among the PTA's,
75%-84% of the assigned schools were able to establish an LGU's and other stakeholders
active partnership among the PTA's, LGU's and other
January- and initiated
10% stakeholders to initiate at least 2 projects to sustain health E- 3 projectsto sustain 4 3
2018 and nutrition programs like WASH in Schools 3 weeks before health and nutrition
the end of school year programs like WASH in
2- Schools T-
60%-74% of the assigned schools were able to establish an 3 weeks before the end of
active partnership among the PTA's, LGU's and other school year
stakeholders to initiate at least 1 project to sustain health
and nutrition programs like WASH in Schools 2 weeks before
the end of school year
1-No partnership was establish
5. Strengthen the advocacy campaign and conduct Blood
Donation among the 34 districts(E) to collect and gather 500
bags and up (Q) 4 weeks before the end of the year (T)
4- Strengthen the advocacy campaign
and conduct Blood Donation among the 22-33 districts(E) to
collect and gather 400-499 bags(Q) and up 3 weeks before
the end of the year (T)
3-Strengthen the advocacy campaign and conduct
Blood Donation among the 11-21 districts(E) to collect and Q-Strengthened the advocacy
gather 300-399 bags(Q) and up 2 weeks before the end of campaign and conducted
January the year (T) Blood Donation among the 20
10% 2-Strengthen the districts E- 3 5
2018 and gathered 736 bags of safe
advocacy campaign and conduct Blood Donation among the
5-10 districts(E) to collect and gather 200-299 bags(Q) and a blood T-a month
month after the end of the year (T) before the end of the year
1--Strengthen the
advocacy campaign and conduct Blood Donation among the
0-4 districts(E) to collect and gather 1-199 bags(Q) and 2
months after the end of the year (T)
Sub- total
Page 4 of 14

BASIC EDUCATION SERVICES
SPECIAL SERVICES (20%)
Attended at least 3 seminars/
trainings (school, district, regional,
national or inter-agency) and 100%
1 of them are health and nutrition
related to continuously improve our
service to learners before the end of
the school year
BASIC EDUCATION SERVICES
SPECIAL SERVICES (20%)
100% of the activities requesting for
medical assistance like trainings,
seminars and sports competition
were attended and casualties were Certifcate of appearance, medical December
2 provided with excellent nursing
intervention and management
immediately upon the onset of
client's discomfort.
DEPEDBATS-ODS-F-004/R0/06-01-2018
Certificates of participation
Travel order, Division memo,
report signed by whoever in
charge of the listed activities
5. Attended 5 or more seminars/trainings by which 100% of
them are Health and nutrition related to continuously
improve our service to learners 5 weeks before the end of
the school year
4- Attended 4
seminars/trainings by which 85%-99% of them are Health
and nutrition related to continuously improve our service to
learners 4 weeks before the end of the school year
3-Attended 3 Q-Attended 5 or more
seminars/trainings by which 75%-94% of them are Health seminars/trainings by which
and nutrition related to continuously improve our service to E-100%
January- learners 3 weeks before the end of the school year of them are Health and
December 10% nutrition related to 5 5
2018 2-Attended 2 seminars/trainings by continuously improve our
which 60%-74% of them are Health and nutrition related to service to learners
continuously improve our service to learners 2 weeks before T-5 weeks before the
the end of the school year end of the school year
1-Attended 1
seminar/training by which 59% and below of them are
Health and nutrition related to continuously improve our
service to learners a week before the end of the school year
5- 100% of the activities requesting for medical assistance like
trainings, seminars and sports competition were attended and
casualties were provided with excellent nursing intervention
and management on the onset of client's discomfort
immediately.
4. 95-99% of the activities requesting for medical
assistance like trainings, seminars and sports competition were
attended and casualties were provided with very satisfactory
nursing intervention and management on the onset of client's
discomfort on time
Q-100% of the activities
3. 90-94-%of the activities requesting for medical assistance requesting for medical
like trainings, seminars and sports competition were attended assistance like trainings,
and casualties were provided with satisfactory nursing seminars and sports
January- intervention and management on the onset of client's competition were attended
discomfort with minimal delay
10% and E-casualties were 5 5
2018 2-85-89% of the provided with excellent
activities requesting for medical assistance like trainings,
nursing intervention and
seminars and sports competition were attended and casualties management on the onset of
were provided with poor nursing intervention and management
client's discomfort
on the onset of client's discomfort with moderate delay
T-immediately.
1-80-84% of the activities requesting for
medical assistance like trainings, seminars and sports
competition were attended and casualties were provided with
very poor nursing intervention and management on the onset
of client's discomfort with severe delay.
Sub - Total
Page 5 of 14
 Total Rating/Average TOTAL RATING

*To get the score, the rating is multiplied by the weight assigned ADJECTIVAL RATING Very S

Total Rating/Average 100% TOTAL RATING

*To get the score, the rating is multiplied by the weight assigned ADJECTIVAL RATING very S

Major Final
Key Result Areas Rating
Output
NUTRITION PROGRAMS AND SERVICES 1.233

HEALTH PROGRAMS AND SERVICES 1.233

LINKAGES 0.700

SPECIAL SERVICES 1.000

Numerical
4.166
Rating
Adjectival
VS
Rating

Ratee: Rater: Approved:

DIANA KRISTINE E. GUTEZA RN, MAN DAVID M. NUAY JOEPI F. F

NURSE II CHIEF EPS, SGPOD Asst. SCHOOLS DIV

Performance Management Team

ARIS U. DIMAANO EDUARDA U. ALON LOU C. PANALIGAN RENAT

Planning Officer III Accountant III AO IV / HRMO Administ

DEPEDBATS-ODS-F-004/R0/06-01-2018 Page 6 of 14
 GINA M. LAKSAMANA AURELIA A. AGUILA DONATO MAGBOO AMEL
EPS I President - PESPA President - Sec. School Prin. Assoc. President - Te

CATHERINE V. MARANAN, Ed.D. JOEPI F. FALQUEZA, Ed.D.

Asst. Schools Division Superintendent Asst. Schools Division Superintendent
CO - CHAIRMAN CHAIRMAN

Category Description Range Adjectival Rating

4.500- 5.000 Outstanding

The extent to which actual performance compare with
Effectiveness/Quality targeted performance
Efficiency The extent to which time or resources is used for the 3.500 - 4.499 Very Satisfactory
intended task or purpose. Measures whether targets are
accomplished with a minimum amount or quantity of waste,
expense, or unnecessary effort.
In management, efficiency relates to doing the things right
clients/stakeholders.
Time-related performance indicators evaluate such things 2.500 - 3.499 Satisfactory
Timeliness as project completion deadlines, time management skills
and other time-sensitive expectations. 1.500 - 2.499 Unsatisfactory
1.499 & below Poor

DEPEDBATS-ODS-F-004/R0/06-01-2018 Page 7 of 14
DAVID M. NUAY
CHIEF EPS, SGOD

TO BE FILLED IN DURING EVALUATION

RATING

SCORE
T AVE.

4 4.000 0.400

3 4.000 0.400

DEPEDBATS-ODS-F-004/R0/06-01-2018 Page 8 of 14
 3 4.333 0.433

1.233

3 4.000 0.400

DEPEDBATS-ODS-F-004/R0/06-01-2018 Page 9 of 14
 4 4.333 0.433

4 4.000 0.400

1.233

DEPEDBATS-ODS-F-004/R0/06-01-2018 Page 10 of 14
 3 3.333 0.333

3 3.667 0.367

0.700

DEPEDBATS-ODS-F-004/R0/06-01-2018 Page 11 of 14
 5 5.000 0.500

5 5.000 0.500

1.000

DEPEDBATS-ODS-F-004/R0/06-01-2018 Page 12 of 14
 4.166

Very Satisfactory

very Satisfactory

Rating

1.233

1.233

0.700

1.000

4.166

VS

JOEPI F. FALQUEZA Ed. D

Asst. SCHOOLS DIVISION SUPERINTENDENT

RENATO M. ACERO
Administrative Officer V

DEPEDBATS-ODS-F-004/R0/06-01-2018 Page 13 of 14
 AMELITA RADAM
President - Teachers Association

Adjectival Rating Scale Definition

Outstanding 5 Role Model

Very Satisfactory 4 Consistently

Demonstrate

Most of the time

Satisfactory 3
demonstrate
Unsatisfactory 2 Sometimes demonstrate
Poor 1 Rarely demonstrate

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