Republic of the Philippines

Department of Education
Region VI - Western Visayas
Division of Antique
PASCUAL M. OSUYOS MOMORIAL HIGH SCHOOL
Aras-asan, Tobias Fornier, Antique

INDIVIDUAL PERFOMANCE COMMITMENTY AND REVIEW FORM (IPCRF)

Name of Employe JOFRED M. MARTINEZ, MAN, RN Name of Rater: AGUSTIN P. ALMERIA

Position: NURSE II Position: HEAD TEACHER I
Division: DEPARTMENT OF EDUCATION/DIVISION OF ANTIQUE Date of Review: APRIL 29, 2016

TO BE FILLED DURING PLANNING TO BE FILLED DURING EVALUATION

PERFORMANCE RATING
MFOs KRAs OBJECTIVES TIMELINE Weight INDICATORS ACTUAL RESULTS SCORE
per KRA (Quality, Efficiency,
Timeliness) Q E T Ave.
Documentation 1. a. Conducted September Conducted and Q - Conducted 100% of the scheduled
on the conduct of health lectures talks 2015 to documented 20 lectures/talks to classes identified within 5
health to classes March 2016 health lectures/ the assigned area of assignment.
lectures/talks talks to clienteles
provided to within the area of
clientele assignment E – Conducted and documented 100% of the
planned lectures to clienteles in schools 5
within the assigned area of assignment. 5

T – Conducted and documented 100% of the

planned lectures to clientele in schools on or 5
1. HEALTH before the schedule indicated in the plan.
PROGRAM 35% 1.575
Report on health SERVICES 1. b. Conducted September 75% of school
status individual health 2015 to children inspected Q - Annual screening procedures for school
assessment of inspection of 75% March 2016 before the end of children conducted in 92% of the total 4
leaners school children March within the school children within the assigned area.
within the area of area of assignment.
responsibility
E – Analyzed and submitted health status 4
report of 75% of school children in all 3
schools of the assigned area.

T – Conducted, analyzed and submitted

health status report of 75% of school 4
children in the assigned areas.
Documentation 1. c. Conducted September 1.c Conducted 100% Q - 100% of children dewormed within the
and report on deworming to all 2015 to deworming session assigned area. 5
deworming by school children of March 2016 to school children of
school within the schools in the schools in the
area of assigned area assigned area E – 100% coordination with the school
responsibility heads/teachers/parents and children was
observed and deworming pills were given to
all students in all schools of the assigned 5 5
area.

T – Conducted deworming to 100% of

school children as scheduled in the plan. 5

Report on 1. HEALTH 1. d. Treated/ September 1. d. 75% and above Q – 85% of pupils with identified ailments
monitoring and PROGRAM referred school 2015 to 35% of pupils with were treated utilizing acceptable treatment
evaluation of SERVICES children with March 2016 identified ailments and medicinal plants. 4
school health and identified ailments were treated/
nutrition related referred to improve
activities health status E – 85% of school children identified with
ailments that require medical treatment
were referred to RHU/physician in all 4
schools of the assigned area. 3

T – Treatment and referral to 85% of school

children conducted on the scheduled date as
planned. 4

Inspection/ 2. a. Inspected the September 2. a. 5-8 lunch Q - 85% of the identified lunch counters and
evaluation report sanitation of lunch 2015 to counters and food food services of the total number of schools
of lunch counters counters and food March 2016 services inspected within the assigned area inspected and
and food services services within the assigned monitored. 4
area

E - 85% of lunch counters and food services

of the total number of schools within the
2. NUTRITION assigned area inspected and monitored.
3
PROGRAM 35% 4 1.663
SERVICES
T – 85% of lunch counters and food services
of the total number of schools within the
assigned area inspected and monitored on
the scheduled date as planned. 4

Terminal and 2. b. Measured September 2. b. 85% of school Q - 100% of school children weighed and
nutritional status height and weight 2015 to children weighed nutritional status determined. 5
report of school of school children March 2016 and nutritional
children and determined status determined
their nutritional
status 5
Terminal and 2. b. Measured September 2. b. 85% of school
nutritional status height and weight 2015 to children weighed
report of school of school children March 2016 and nutritional
children and determined status determined E - 100% coordination with the school
their nutritional heads/teachers/parents and children was
observed during the determination of 5
status 5
nutritional status.

T - 100% of school children weighed and

nutritional status determined on the 5
scheduled date as planned.
SBFP Terminal 2. c. Monitored September 2. c. 85% school- Q - 100% of school-based feeding program
Report and SBFP implementation of 2015 to based feeding and related activities monitored and 5
Monitoring and school-based March 2016 program and related evaluated.
Evalution Form feeding program activities monitored
and related and evaluated E - 100% coordination with the school
activities heads/teachers/parents and children was
observed during the monitoring and
evaluation of school-based feeding program 5
5
and related activities.

T - 100% monitoring and evaluation of

ichool-based feeding program and related 5
2. NUTRITION activities within the period of performance
PROGRAM 35% appraisal.
SERVICES
Certificate of 2. d. Attended September 2. d. 85% of regular Q - 100% of HNS Monthly Meeting attended
Appearance regular HNS 2015 to HNS Monthly and reports submitted 5
Monthly Meeting March 2016 Meeting attended
and submitted and reports
reports submitted E - 100% of HNS Monthly Meeting attended 5
and reports submitted promptly. 5

T - 100% of HNS Monthly Meeting attended

and reports submitted within the period of 5
performance appraisal.
Certificate of 2. e. Served as September 2. e. Two invitations
recognition/ resource speaker in 2015 to of nutrition related Q - Served as resource speaker in 100% of
appearance nutrition related March 2016 activities served the total number of invitations to health 5
activities related activities.

E - 100% of speakerships served and

documented of the total number of 5 5
invitations to health related activities.

T - Served as resource speaker in 100% of

the total number of invitations to health 5
related activities within the period of
performance appraisal.
Certificate of 3. a. Attended September 3. a. 85% of Q - Attended 100% meetings/seminars and
recognition/ meetings/ seminars 2015 to meetings/ seminars other school health related activities within
appearance and other school March 2016 and other school the period of appraisal attended. 5
health related health related
activities activities within the
period of appraisal E - 100% meetings/seminars and other
school health related activities attended and
attended documented. 5
5

T - 100% meetings/seminars and other

school health related activities attended and
documented within the period of appraisal 5
attended.

3. b. Encouraged September 3. b. 85% of school Q - 100% of schools implemented school-

school heads for 2015 to implemented school based feeding thru self-help or partnership
school-based March 2016 heads for school- agreements for sustainable health and 4
feeding based feeding thru nutrition program.
implementation self-help or
thru self-help or partnership E - 100% coordination with the school
partnership agreements for heads/teachers/parents and children was
agreements for sustainable health observed during the implementation of
sustainable health and nutrition school-based feeding thru self-help or
and nutrition program partnership agreements for sustainable 4
3. PARTNERSHIPS program 10% 4 0.467
health and nutrition program.

T - 100% of schools implemented school-

based feeding thru self-help or partnership
agreements for sustainable health and
nutrition program within the period of 4
appraisal attended.

Certificate of 3. c. Maintained September 3. c. 85% of EHCP Q - 100% of EHCP materials were

recognition/ and monitored 2015 to materials were distributed and utilized by schools. 5
appearance EHCP March 2016 distributed and
implementation in utilized by schools
schools E - 100% coordination with the school
heads/teachers/parents and children was
observed during the distribution and 5
utilization of EHCP materials by schools. 5

T - 100% of EHCP materials were

distributed and utilized by schools within
the period of appraisal. 5

Certificate of 4. a. Served as first- September 4. a. Served as first - Q - Served as first-aider to 100% of sports
appearance aider to 85% of 2015 to aider to 100% of activities, scouting and other events within 5
sports activities, March 2016 Sports activities, the area of responsibility.
scouting and other Scouting, and other
events within the events within the E - Served and documented services as first-
area of period of appraisal aider to 100% of sports activities, scouting
responsibility and other events within the area of 5 5
responsibility.
Certificate of 4. a. Served as first- September 4. a. Served as first -
appearance aider to 85% of 2015 to aider to 100% of
sports activities, March 2016 Sports activities,
scouting and other Scouting, and other
events within the events within the
area of period of appraisal
responsibility 5

T - Served as first-aider to 100% of sports

activities, scouting and other events within 5
the period of appraisal attended.
Documentation 4. b. Provided September 4. b. Provided Q - Provided assistance to 85% of learners
of first aider assistance to 85% 2015 to assistance to 85% of and teachers in disaster preparedness and
during disaster, medical/dental March 2016 learners and emergencies. 4
emergencies and missions and health teachers in disaster
conflicts. teachings regarding preparedness and E - Provided assistance and documented
disaster emergencies services to 85% of learners and teachers in
emergencies, disaster preparedness and emergencies. 4
4. SPECIAL calamities and 4
20% 0.93333
SERVICES conflicts
T - Provided assistance to 85% of learners
and teachers in disaster preparedness and
emergencies within the period of appraisal 4
attended.

Treatment record 4. c. Conducted September 85% of participating Q - Conducted medical examination to 100%
and certificate of medical 2015 to athletes were given of athletes for WVRAA, Provincial Meet, and 5
appearance examination to March 2016 medical other tournament.
athletes for examination.
WVRAA, Provincial E - Conducted and documented medical
Meet, and other examination to 100% of athletes for
tournament. WVRAA, Provincial Meet, and other 5
tournament. 5

T - Conducted medical examination to 100%

of athletes for WVRAA, Provincial Meet, and
other tournament within the period of 5
appraisal attended.

To get the score, the rating is multiplied by the weight assigned. OVERALL RATING FOR ACCOMPLISHMENTS 4.6375

Rater: Ratee: Recommending Approval:

AGUSTIN P. ALMERIA JOFRED M. MARTINEZ EVELYN C. REMO

Head Teacher I Nurse II Chief, School Governance and Operation Division
 INDIVIDUAL DEVELOPMENT PLAN (IDP)
Name: MARTINEZ, JOFRED M. Two-Year Period
Current Position: NURSE II Division ANTIQUE
Salary Grade: 15 Office PASCUAL M. OSUYOS MEMORIAL HIGH SCHOOL
Years in Posiion: 9 Months No further development is desired or required for this year/s (Please check the box below)
Years in the DepEd 9 Months Year 1 Year 2 Both Years
Purpose: (√) To meet the Core Behavioral Competencies in: *Self Management (C & D) * To increase level of competence in current position
*Professionalism and Ethics (B-E) * To acquire new competencies in different functions
(√) To meet the Key Results Area in: *Oral Communication (B) * Others, please specify

COMPETENCY ASSESSMENT AND DEVELOPMENT PLAN

PRIORITY SPECIFIC BEHAVIORAL SUPPORT TRAINER/ SCHEDULE OR
UNMET/TARGET DEVELOPMENT ACTIVITY
COMPETENCY [1] FOR IDP CODE INDICATORS NOT [4] NEEDED PROVIDER COMPLETION DATE
[2] DEMONSTRATED [3] [5] [6] [7]

Employee Signature Date Supervisor's Signature Date Head of Office Signature Date

APRIL 29, 2016 APRIL 29, 2016

JOFRED M. MARTINEZ AGUSTIN P. ALMERIA
Updated (initials) Date Updated (initials) Date Updated (Initials) Date

Check applicable copy designated as shown: Employee's Copy Department Head's Copy Principal's Copy
 Republic of the Philippines
Department of Education
Region VI - Western Visayas
Division of Antique
PASCUAL M. OSUYOS MOMORIAL HIGH SCHOOL
Aras-asan, Tobias Fornier, Antique

PART III: SUMMARY OF RATING FOR DISCUSSION

Final Performance Result Rating Adjectival Rating

Accomplishment of KRAs and Objectives

RATER-RATEE AGREEMENT
The signature below confirms that the employee and his/her superior have agreed on content of this appraisal form and performance rating.

Name of Ratee Name of Rater

Signature: Signature:
Date: Date:

PART IV: DEVELOPMENT PLANS

RESOURCE
STRENGTHS DEVELOPMENT NEEDS ACTION PLAN TIMELINE NEEDED
Professionalism and
Ethics
Result Focus
Innovation
Teamwork
Computer Skills

JOFRED M. MARTINEZ, MAN, RN AGUSTIN P. ALMERIA

Nurse II Head Teacher I
 1. CORE BEHAVIORAL COMPETENCIES
SELF-MANAGEMENT
A. Sets personal goals and direction, needs and development.
B. Undertakes personal actions and behaviors that are clear and purposive and takes into
goals and values congruent to that of the organization.
C. Displays emotional maturity and enthusiasm for and is challenged by higher goals.
D. Prioritize work tasks and schedules (through gant charts, check list, etc.) to achieve goals.
E. Sets high quality, challenging, realistic goals for self and others.
PROFESSIONALISM AND ETHICS
A. Demonstrates the values and behavior enshrined in the Norms of Conduct and Ethical
Standards for public officials and employees (RA 6713)
B. Practices ethical and professional behavior and conduct taking into account the impact
of his/her actions and decisions.
C. Maintains a professional image; being trustworthy, regularity of attendance and
punctuality, good grooming and communication.
D. Makes personal sacrifices to meet the organization's needs.
E. Acts with a sense of urgency and responsibility to meet the organization's needs,
improve systems and help others improve their effectiveness.
RESULT FOCUS
A. Achieves results with optimal use of time and resources most of the time.
B. Avoids network, mistakes and wastage through effective work methods by placing
organizational needs before personal needs.
C. Delivers error-free outputs most of the time by conforming to standard operating
procedure very satisfactory quality of work in terms of usefulness/acceptability and
completeness with no supervision required.
D. Expresses a desire to do better and may express frustration at waste or inefficiency.
May focus on new or more precise ways of meeting goals set.
E. Makes specific changes in the system or in own work methods to improve performance.
Examples may include doing something better, faster, at a lower cost, more effeciently;
or improving quality, customer satisfaction, morale, without setting any specific goal.
TEAMWORK
A. Willingly does his/her share of responsibility.
B. Promotes collaboration and removes barriers to teamwork and goal accomplishment
across the organization.
C. Applies negotiation principles in arriving at win-win agreements.
D. Drives consensus and team ownership of decisions.
E. Works constructively and collaboratively with others and across organizations to
accomplishorganization goals and objectives.
SERVICE ORIENTATION
A. Can explain and articulate organizational directions, issues and problems.
B. Takes personal responsibility for dealing with and/or correcting customer service
issues and concerns.
C. Initiates activities that promotes advocacy for men and women empowerment.
D. Participates in updating of office vision, mission, mandates and strategies based on
 DepEd strategies and directions.
E. Develops and adopts service improvement programs through simplified procedures
that will further enhance service delivery.
INNOVATION
A. Examines the root cause of problems and suggests effective solutions. Fosters new
ideas, processes & suggests better ways to do things (cost and/or operational efficiency).
B. Demonstrates an ability to think "beyond the box". Continuously focuses on improving
personal productivity to create higher value and results.
C. Promotes a creative climate and inspires co-workers to develop original ideas or solutions.
D. Translates creative thinking into tangible changes and solutions that improve the work unit
and organization.
E. Uses ingenious methods to accomplish responsibilities. Demonstrates resourcefulness
and the ability to succeed with minimal resources.
2. CORE SKILLS
ORAL COMMUNICATION
A. Follows instructions accurately.
B. Expresses self-clearly, fluently and accurately.
C. Uses appropriate medium for the message.
D. Adjust communications style to others.
E. Guides discussions between and among peers to meet an objective.
WRITTEN COMMUNICATION
A. Knows the different written business communication formats used in the DepEd
B. Writes routine correspondence/communications, narrative and descriptive report based
on readily available information data with minimal spelling or grammatical errors
(e.g. memos, minutes, etc.)
C. Secures information from required references (i.e., directories, schedules, notices,
instructions) for specific purposes.
D. Self-edits words, numbers, phonetic notation and content, if necessary.
E. Demonstrates clarity, fluency, impact, conciseness and effectiveness in his/her
written communications
COMPUTER/ ICT SKILLS
A. Prepares basis composition (e.g., letters, reports, spreadsheets and graphics
presentation using Word Processing and Excel.
B. Identifies different computer parts, turns to computer on/off, and work on a given task
with acceptable speed and accuracy and connects computer peripherals (e.g., printers,
modes, multimedia projectors, etc).
C. Prepares simple presentation using Powerpoint.
D. Utilizes technologies to: access information to enhance professional productivity,
assists in conducting research and communicate through local and global professional
network.
E. Recommends appropriate and updated technology to enhance productivity and
professional proctice.
 CORE BEHAVIORAL COMPETENCIES TOTAL
CORE SKILLS TOTAL
GRAND TOTAL

5 - Role model
4 - Consistently demonstrates
3 - Most of the time demonstrates
2 - Sometimes demonstrates
1 - Rarely demonstrates

Note: These ratings can be used for the development plans of the employee.
 1. CORE BEHAVIORAL COMPETENCIES
SELF-MANAGEMENT RATING AVERAGE
ection, needs and development.
ns and behaviors that are clear and purposive and takes into
t to that of the organization.
0.000
ty and enthusiasm for and is challenged by higher goals.
chedules (through gant charts, check list, etc.) to achieve goals.
ng, realistic goals for self and others.
PROFESSIONALISM AND ETHICS RATING AVERAGE
nd behavior enshrined in the Norms of Conduct and Ethical
als and employees (RA 6713)
ssional behavior and conduct taking into account the impact

mage; being trustworthy, regularity of attendance and 0.000

g and communication.
to meet the organization's needs.
cy and responsibility to meet the organization's needs,
others improve their effectiveness.
RESULT FOCUS RATING AVERAGE
mal use of time and resources most of the time.
and wastage through effective work methods by placing
e personal needs.
most of the time by conforming to standard operating
y quality of work in terms of usefulness/acceptability and
ervision required. 0.000
etter and may express frustration at waste or inefficiency.
precise ways of meeting goals set.
he system or in own work methods to improve performance.
ng something better, faster, at a lower cost, more effeciently;
mer satisfaction, morale, without setting any specific goal.
TEAMWORK RATING AVERAGE
re of responsibility.
d removes barriers to teamwork and goal accomplishment

ples in arriving at win-win agreements. 0.000

m ownership of decisions.
ollaboratively with others and across organizations to
oals and objectives.
SERVICE ORIENTATION RATING AVERAGE
organizational directions, issues and problems.
ity for dealing with and/or correcting customer service

motes advocacy for men and women empowerment.

0.000
office vision, mission, mandates and strategies based on
 0.000

ce improvement programs through simplified procedures

ervice delivery.
INNOVATION RATING AVERAGE
of problems and suggests effective solutions. Fosters new
sts better ways to do things (cost and/or operational efficiency).
to think "beyond the box". Continuously focuses on improving
create higher value and results.
mate and inspires co-workers to develop original ideas or solutions. 0.000
king into tangible changes and solutions that improve the work unit

to accomplish responsibilities. Demonstrates resourcefulness

d with minimal resources.
2. CORE SKILLS
ORAL COMMUNICATION RATING AVERAGE

uently and accurately.

m for the message. 0.000
style to others.
een and among peers to meet an objective.
WRITTEN COMMUNICATION RATING AVERAGE
tten business communication formats used in the DepEd
ndence/communications, narrative and descriptive report based
rmation data with minimal spelling or grammatical errors

m required references (i.e., directories, schedules, notices, 0.000

c purposes.
rs, phonetic notation and content, if necessary.
ency, impact, conciseness and effectiveness in his/her

COMPUTER/ ICT SKILLS RATING AVERAGE

ion (e.g., letters, reports, spreadsheets and graphics
Processing and Excel.
puter parts, turns to computer on/off, and work on a given task
nd accuracy and connects computer peripherals (e.g., printers,
jectors, etc).
ation using Powerpoint. 0.000
access information to enhance professional productivity,
search and communicate through local and global professional

te and updated technology to enhance productivity and

 CORE BEHAVIORAL COMPETENCIES TOTAL 0.000
CORE SKILLS TOTAL 0.000
GRAND TOTAL 0.000

monstrates
me demonstrates

used for the development plans of the employee.