ANNEX C

INDIVIDUAL PERFORMANCE COMITMENT AND REVIEW

I FERNANDO, DIVINE BETTINA__ of the ILOCOS SUR PROVINCIAL HOSPITAL-GABRIELA SILANG
commit to deliver and agree to be rated on the attainment of the following targets in accordance with the
indicated measures for the period ________________________________
DIVINE BETTINA A. FERNANDO., RN
DATE:______________________

REVISED BY

DATE

Approved by:

REMEDIOS R. RAGASA
Nurse Supervisor

DATE

TRINA TABBOGA-TALAGA
Head of Office
5- Outstanding
4- Very Satisfactory
3- Satisfactory
2- Unsatisfactory
1- Poor

MFO/PAP

Success Indicator
(Target + Measure)

Alloted
Budget

Actual
Accomplishments

Ratings

Remarks

4.33

4.57

Provided Safe and Quality Patients Care

Managed and responsible in providing the 100% managed and provided
nursing care for Medical Intensive Care Unit nursing care to ICU and 100%
accuracy
Planned, implanted and evaluated
nursing care given to ICU patient

the 100% planned, implanted and

evaluated the nursing care given
to ICU patient

100% managed and provided nursing

care to ICU and 100% accuracy

100%
planned,
implanted
and
evaluated the nursing care given to ICU
patient

Core Functions:
Received and endorsed the unit with well Endorsed and received 2x for 15
maintained sterility and cleanliness with minutes
daily
with
95%
adequate medical and surgical supplies, acceptability
equipment and instruments

Endorsed and received 2x for 15 4

minutes daily with 95% acceptability

4.57

Carried out doctors orders, treatments and Doctors orders carried out
diagnostic examination
immediately with 100% accuracy

Doctors
orders
carried
immediately with 100% accuracy

out 5

Provided morning care and assisted patient in 15-20 minutes with 2-3 patients
their activities of daily living
daily with 95% accuracy

3 patients daily for 15minutes per 5

patient with 95% accuracy

4.57

Assisted the physician during special Assisted physician during special

procedures such as intubation, insertion of procedures wit 100% accuracy
NGT, tracheostomy etc.

Assisted physician during

procedures wit 100% accuracy

special 5

4.57

Performed cardiopulmonary resuscitation As needed, CPR performed

during
patients
arrest,
administered immediately with 100% accuracy
emergency drugs as ordered

Resuscitated patients during arrest and 5

administered emergency drugs as
ordered

4.57

Recorded assessment, intervention and Done daily 10-15 minutes per

evaluations of nursing care done to patients chart with 100% accuracy
and maintained confidentiality

10minutes
accuracy

100% 5

4.57

Performed post-mortem care & responded to Performed post mortem care

emotional needs of significant others
with 90% acceptability

Performed post mortem care with 90% 5

acceptability

recording

with

Support Functions
reports Submitted reports, assignments
and daily census a day before on
100% accuracy

Submitted reports, assignments and 5

daily census a day before on 100%
accuracy

Attended monthly meetings, seminars and As scheduled of meetings

conferences
attended and 4 seminars with
95% accuracy

As scheduled of meetings attended and 5

4 seminars with 95% accuracy

4.57

Maintained cleanliness and orderliness of the Cleanliness

and
orderliness
unit
maintained
with
100%
acceptability

Cleanliness and orderliness maintained 5

daily with 100% acceptability

4.57

Attended ceremonies
acceptability

4.57

Accomplishment and submitted

assignments and daily census

Attended flag raising and flag retreat

Attended ceremonies with 90%

acceptability

with

90% 4

4.57

Comments and Recommendations for Development Purposes

Average rating
CATEGORY

MFO

RATING

Core Functions

(42.35) 4.70 x.85 = 3.995

Support Functions

(18.34) 4.585 x .15 = .687

4.68

Total Overall Rating

Final Average Rating
Adjectival Rating

VS
DATE

FINAL RATING BY:

Head of OPMIS
DISCUSSED with:

DATE
COMMISION

Date

Assessed by:

Approved by:

FERNANDO, DIVINE BETINA, RN

Teresita F. Agatep, RN, MAN

Trina Tabboga-Talaga

Employee

Chief Nurse

Head of Office

Date