FORM C

INDIVIDUAL PERFORMANCE COMMITMENT AND REVIEW (IPCR)

I, Jenivic E. Puedan of the Nursing Service Department, commits to deliver and agree to be rated on the attainment of the following targets in
accordance with the intended measures for the period January to June 2017.

JENIVIC E. PUEDAN, RN
Employee/Ratee
Date: _________________________
Reviewed By: Date Approved by: Date
MARITES D. ENRIQUEZ,RN ARSENIA M. GARRIDO, RN, MAN, MPH
Immediate Supervisor Department Head

SUCCESS INDICATORS ACTUAL RATING REMARKS

OUTPUT
(TARGETS+MEASURES) ACCOMPLISHMENT Q E T A
STRATEGIC OBJECTIVES:
I. Civil Service Commission
Prime Human Resource
Management Accreditation
Program Attend / undergo at least 4 hours of Attended 8 hours of Relevant
A. Strategic Human Human Resource Intervention by Human Resource
Resource Program EO June 2017 Intervention: 5 5 5 5 8 hours
Compliance BURNS 101
1. Capacity Development Date: March 7, 2017
Program (Human
Resource PROPER INJECTION
TECHNIQUES
Intervention)
Date: May 2, 2017

B. SPMS Implementation
1. IPCR target of July to Prepare and submit 1st semester Prepared and submitted IPCR
December 2017 IPCR target by June 10, 2017 without target on June 10, 2017 with
corrections. minor corrections. `
5 3 4

2. IPCR Prepare and submit 2nd semester
Accomplishment of IPCR accomplishment by January 10,
July December 2017 without corrections.
2016
Obtain a rating of Very Satisfactory
(VS) in the 1st semester of 2017.
Prepared and submitted IPCR
accomplishment with minor 3 3 3
errors on January 10, 2017.
Obtained a rating of Very
Satisfactory (VS) 3.99 4 3 3.66

3. Form E
STRATEGIC OBJECTIVES RATING:
CORE FUNCTIONS
Nursing Services
1. Compliance to ward policies
2. Endorsement rounds
Prepare and submit Form E for Daily Prepared and submitted Form 4
Accomplishment Report every 2nd day E for Daily Accomplishment
of the month. Report every 2nd day of the 3 3 3
month.
18.66 5 = 3.7 x 0.4=1.5
100% comply with the policies and 100% complied with the
standard every duty. policies and standard every 5 3 4
duty.
Do ward rounds before and after shift 100% ward rounds conducted
 within 2 hours. before and after shift within 2 5 5 5
hours.
3. Quality Patient Care 100% of nursing care procedures All 3398 (100%) nursing care
from admission to discharge carry out procedures from admission to 5 5 5 5
promptly. discharge carried out promptly.

3058 out of 3398 (90%)

100% of patients relatives are patients relatives
satisfy/happy with the services they satisfied/happy with the 4 4 4
receive. services received.
4. Quality Patient Care 100% of patients charts accurately & 3058 out of 3398 (90%) of
completely recorded within the shift. patients charts accurately & 4 4 4 4
completely recorded within the
shift.

-FDAR 100% complies 3058 out of 3398 (90%) FDAR 4 4

5. Nursing procedures
6. Health Education Activities
7. Referral Slip
7.1.Emergency
7.2. non - urgent
8. Best Practice
9. Compliance to 5S
10. Compliance to code of ethics
- 100% of doctors orders
accurately carry out
100% of nursing procedure accurately
done
100% of patients and watchers
educate.
Coordinate 100% of referrals within
10 minutes upon doctors order.
Coordinate 100% of referrals at least
1 hour upon doctors order.
Complies with best practice
Maintain cleanliness & orderliness of
the unit daily.
Wear proper and clean uniform at all
times during duty.
complied
All 3398 (100%) doctors
orders carried out accurately. 5 5
All 3398 (100%) nursing 5 5 5
procedures accurately done.
All 3398 (1000%) watchers
5 5 5
educated at least 30 minutes..
All 271 (100%) referrals
coordinated within 30 minutes
5 5 5
upon doctors order.
243 out of 271 (90%) of
4 4 4
referrals coordinated at least 1
hours upon doctors order.
Complied with best practice 5 5 5
Maintained cleanliness &
3 4
orderliness of the unit daily.
Wore proper and clean uniform
5 5 5
at all times during duty.
 11. DTR Completely sign and submit every Completely signed and 5 5 5 5
23rd day of the month submitted every 23rd day of
COMMENTS AND RECOMMENDATIONS FOR DEVELOPMENT PURPOSES: the month.
CORE RATING 6915=4.6x 0.3 =1.4
SUPPORT FUNCTIONS
DISCUSSED WITH: DATE ASSESSED BY: DATE FINAL RATING BY: DATE
1. Attends meeting 100% attendance
I certifytothat
meeting 3 unit meetings attended.
I discussed my 5 5
a. Unit meeting 3 assessment of the performance with
b. General meeting - 3 the employee. 3 general meetings attended.
2. Membership to different Membership to different committees 100% compliance 5 5 PNA MEMBER
committees & association and association renewal/comply
3. Performance of other tasks Act upon 100% of assigned tasks 80% of assigned tasks are 1 1
as may
JENIVIC E. be assigned
PUEDAN, RN from effectively.
PAMFILA A. FIJER RN, MAN effectively acted upon.
ARSENIA M. GARRIDO, RN, MAN, MPH
timeEMPLOYEE
to time. IMMEDIATE SUPERVISOR DEPARTMENT HEAD
SUPPORT RATING 113=3.6 x3 =1.09
FINAL AVERAGE RATING 3.99