DOH - SPMS Form 1 Document Code:

DIVISION PERFORMANCE COMMITMENT AND REVIEW (DPCR) Revision No.: 0

Effectivity: July 14, 2020

I, CHRISTIAN M. CAMACHE, Rural Health Physician of Dinas, Zamboanga del Sur, commit to deliver and agree to be rated on the attainment of the following targets in accordance with the indicated measures for the period January 1 - December 31, 2021.

Name of Employee: CHRISTIAN M. CAMACHE, MD Date: 1/29/2021

Rural Health Physician
Approved By:

AGNES B. FERNANDO, RN, MAN, PhD. Date: January 29, 2021

DMO V

Actual Accomplishment RATING

(e ) (g) Remarks/ Justification of
Division/Unit Accomplishment
Strategic Goals and Objectives Success Indicators and Target Alloted Budget Unmet Targets
Accountable Rate
(a) (b) (c ) Actual (use separate sheet if needed)
(d) Raw Data (f) Q E T A
Accomplish (h)
(if applicable) (1) (2) (3) (4)
ment
Strategic Functions

1) 100% of LGUs & other stakeholders provided technical

support on province, city and municipal-wide health systems
integration

N:
1.1) Conduct of Strategic Health Investment Planning Activity
- RHU Dinas
(assigned municipality)
D:

N:
1.2) Identification, assessment and consolidation of LGU Health
- RHU Dinas
1) Engage LGUs and local stakeholders to Investment Needs D:
support province and city-wide health
systems integration N:
1.3) Development of Municipal Investment Plan for Health/
- RHU Dinas
Municipal Annual Operational Plan for Health
D:

1.4) Generation and consolidation of FHSIS data, LGUHSC data at N:

- RHU Dinas
the Municipal/City Level
D:

N:
1.5) Actual Assessment of LGUs using the Maturity Model/ UHC
- RHU Dinas
readiness
D:

Average Rating (Strategic Functions) 0.00

Core Functions

2) 100% of policies and programs with dissemination

2) To ensure that relevant policies, campaigns/ activities conducted
guidelines, and programs are cascaded to
LGUs and other health partners N:
2.1) Facilitate the conduct of Municipal DSO/MESU Meeting - RHU Dinas
D:
 N:
2.2) Consultative Meeting with HRH (assigned area) - RHU Dinas
D:

N:
2.3) Facilitate the conduct of LHB Meetings - RHU Dinas
D:

N:
2.4) Roll-out of DOH Program Policies and Guidelines to
- RHU Dinas
barangays and other health partners D:

N:
2.5) Conduct of Municipal/ City Performance Management Review - RHU Dinas
D:

N:
2.6) Development of local health policies for implementation at the
- RHU Dinas
LGU level D:

3) 100% of LGUs and other health partners provided with

technical assistance

3.1) Facilitate the Establishment and functionalization of M/CESU N:

- RHU Dinas
in the municipality/city D:

3.2) Conduct feedbacking on 2021 LGU HSC Performance Results N:

- RHU Dinas
to LGUs during LHB Meeting D:
N:
3.3) Conduct monitoring of MDA implementation - RHU Dinas
D:

3.4) Conduct regular medical consultation and referral of serious N:

- RHU Dinas
case/s to appropriate facilities D:

3.5) Conduct medico-legal services (including investigations when N:

- RHU Dinas
3) To ensure efficacy on the provision of necessary) D:
technical assistance to LGUs and other
health partners towards the achievement N:
3.6) Conduct of RCM activities during disease outbreak response
of UHC - RHU Dinas
immunization D:

3.7) Roll-out Health Promotion Activities in assigned areas (act as N:

- RHU Dinas
resource person) D:
N:
3.8) Conduct of Covid-19 surveillance and response activities - RHU Dinas
D:

3.9) Conduct of barangay medical outreach programs at least once a N:

- RHU Dinas
year D:

3.10) Conduct of barangay blood donation drive (1% of the target N:

- RHU Dinas
population) D:

3.11) Conduct of risks assessment among 20 years old and above N:

- RHU Dinas
using the PhilPEN protocol D:
 3.12) Capacitate RHU personnel on health programs through N:
- RHU Dinas
trainings D:
N:
3.13) Conduct of contact tracing activities at the barangays - RHU Dinas
D:

4) 100% of required plans and reports submitted to repository

offices within the prescribed timeline

N:
4.1) Preparation and submission of 2022 WFP and PPMP - RHU Dinas
D:

4.2) Development of Annual area-based Health Plan (based on the N:

- RHU Dinas
community diagnosis) and submit it to ZPCHD D:

4.3) Preparation of Individual Performance Commitment Review N:

- RHU Dinas
Target and Accomplishment Report D:

4.4) Submission of Semi-Annual Accomplishment Report to the N:

- RHU Dinas
HRDU D:

4) To ensure timely submission of reports/ N:

plans to appropriate repository offices 4.5) Submission of Assessment Tool for LHS - Maturity Model - RHU Dinas
based on ARTA D:
N:
4.6) Submission of MIPH/AOP to PHO and PDOHO - RHU Dinas
D:

4.7) Submission of Consolidated Municipal/City Health Investment N:

- RHU Dinas
Needs D:
N:
4.8) Submission of Quarterly FHSIS Reports - RHU Dinas
D:

4.9) Development or Updating of DRRM-H Plans and submit to N:

- RHU Dinas
PDOHO and DOH ZPCHD D:

4.10) Facilitate submission of Facility Inventory Report of N:

- RHU Dinas
commodities (assigned area) D:
Average Rating (Core Functions)
Support Functions
1) 100% of health facilities monitored for continuous
- 0.00
compliance (regulatory policies and program guidelines)

N:
1.1) Facilitate the establishment of a Functional EMR - RHU Dinas
D:

1.2) Facilitate RHUs Philhealth accreditation and DOH licensing N:

- RHU Dinas
requirements D:
1) To ensure compliance of health
facilities with regulatory policies and
N:
program guidelines 1.3) Conduct stock inventory of all DOH provided essential drugs
- RHU Dinas
and medicines
1) To ensure compliance of health
facilities with regulatory policies and
program guidelines 1.3) Conduct stock inventory of all DOH provided essential drugs
- RHU Dinas
and medicines
D:

N:
1.4) Establishment of a functional ORT Corner/ WASH - RHU Dinas
D:

1.5) Monitor RHUs implementation of MIPH/AOP identified N:

- RHU Dinas
programs, projects and activities D:

2) 100% of outbreak/ epidemiologic investigations conducted

2.1) Conduct of malaria case investigation and response (As N:

- RHU Dinas
needed) D:
N:
2) To ensure the provision of immediate 2.2) Assessment of identified barangays with zero human and
- RHU Dinas
investigation to outbreaks in identified animal rabies case D:
population
2.3) Assessment of barangays service capability on Aedes-borne N:
- RHU Dinas
viral disease program D:

2.4) Assist in the conduct of rapid health assessments in assigned N:

- RHU Dinas
areas (during disaster and epidemic) D:

3.1) 95% Obligation Utilization Rate - 0.00

3.1.1) Facilitate processing of documents for obligation including N:

- RHU Dinas
3) To ensure efficient utilization of DOH utilities, fuels, oils, and other office supplies/ expenses D: 2650000
funds
3.2) 75% Disbursement Utilization Rate - 0.00

N:
3.2.1) Facilitate payment for all obligations - RHU Dinas
D:
4.1) 100% of documents/ requests processed within the
- 0.00
prescribed timeline

4.1.1) Procurement of Office and Janitorial Supplies, IT Equipment N:

- RHU Dinas
and other office supplies D:
4) To ensure compliance with cross-
cutting requirements based on standard N:
procedures and timelines in accordance to 4.1.2) Preparation and processing of various reports - RHU Dinas
D:
ARTA and other relevant laws
4.2) 100% of non-conformities responded with RFA with the
- 0.00
prescribed timeline

N:
4.2.1) Audit Observations Memorandum (AOM) compliance - RHU Dinas
D:
Average Rating (Support Functions) 0.00
RATING

Final Rating per

Adjectival
Average Rating Function Final Rating
Function Percentage Distribution Rating Remarks
per Function (Average Rating x (i)
(j)
Percentage Distribution)

Strategic Functions 40% 0.00 0.00

Core Functions 50% 0.00 0.00 0.00
Support Functions 10% 0.00 0.00
Prepared by (k): Date: Validated and Approved by (l): Date:

CHRISTIAN M. CAMACHE 29-Jan-21 AGNES B. FERNANDO, RN, MAN, PhD

Rural Health Physician Director III/ Chair, PMT
For PMT use, do not fill-up columns (m) & (n)
Assessed by (m): Date: Final Rating by (n): Date:

CHARLOU E. PELIGRO AUGUSTO MANOLO G. ALPICHI, MD, MPH

DMO IV/ HEAD, PLANNING OIC - Director III/ PMT Chair
Legend: 1- Quality 2 -Efficiency 3 - Timeliness 4 - Average (100% and above) (70%-99%) (69% - below)
DOH - SPMS Form 1 Document Code:
DIVISION PERFORMANCE COMMITMENT AND REVIEW (DPCR) Revision No.: 0
Effectivity: July 14, 2020

I, ____________________________, Dentist of __________, __________________(province), commit to deliver and agree to be rated on the attainment of the following targets in accordance with the indicated measures for the period January 1 - December 31, 2021.

Name of Employee: COCO MARTIN Date: 1/29/2021

Dentist
Approved By:

AGNES B. FERNANDO, RN, MAN, PhD. Date: January 29, 2021

DMO V

Actual Accomplishment RATING

(e ) (g) Remarks/ Justification of
Division/Unit Accomplishment
Strategic Goals and Objectives Success Indicators and Target Alloted Budget Unmet Targets
Accountable Rate
(a) (b) (c ) Actual (use separate sheet if needed)
(d) Raw Data (f) Q E T A
Accomplish (h)
(if applicable) (1) (2) (3) (4)
ment
Strategic Functions

1) 100% of LGUs & other stakeholders provided technical

support on province, city and municipal-wide health systems
integration

N:
1.1) Conducts community dental survey in assigned area - RHU Dinas
D:

1) Engage LGUs and local stakeholders to N:

support province and city-wide health 1.2) Identification, assessment and consolidation of dental health
- RHU Dinas
systems integration needs of the assigned community
D:

N:
1.3) Development of Annual area based oral health plan - RHU Dinas
D:

1.4) Establish two-way referral and follow-up systems in the N:

- RHU Dinas
assigned RHU (supported with MOVs)
D:

Average Rating (Strategic Functions) 0.00

Core Functions

2) 100% of policies and programs with dissemination

2) To ensure that relevant policies, campaigns/ activities conducted
guidelines, and programs are cascaded to
LGUs and other health partners N:
2.1) Roll-out of DOH Program Policies and Guidelines to
- RHU Dinas
barangays and other health partners
D:
 N:
2.2) Development of local health policies for implementation at the
- RHU Dinas
LGU level
D:

3) 100% of LGUs and other health partners provided with

technical assistance

3.1) Conduct regular medical consultation and referral of serious N:

- RHU Dinas
case/s to appropriate facilities D:
3) To ensure efficacy on the provision of N:
technical assistance to LGUs and other 3.2) Roll-out Health Promotion Activities in assigned areas (act as
- RHU Dinas
health partners towards the achievement resource person) D:
of UHC
3.3) Conduct of barangay medical/ dental outreach programs at N:
- RHU Dinas
least once a year D:

3.4) Management and Distribution of logistics relared to oral health N:

- RHU Dinas
services D:

4) 100% of required plans and reports submitted to repository

offices within the prescribed timeline

N:
4.1) Preparation and submission of 2022 WFP and PPMP - RHU Dinas
D:

4.2) Submission of Annual area-based Oral Health Plan to PDOHO N:

- RHU Dinas
and ZPCHD D:
4) To ensure timely submission of reports/
plans to appropriate repository offices
based on ARTA 4.3) Preparation of Individual Performance Commitment Review N:
- RHU Dinas
Target and Accomplishment Report D:
N:
4.4) Submission of Monthly Accomplishment Report to the HRDU - RHU Dinas
D:

4.5) Submission of Consolidated Dental/ Oral Health Investment N:

- RHU Dinas
Needs (incorporated in the municipal health investment needs) D:
Average Rating (Core Functions)
Support Functions
1) 100% of health facilities monitored for continuous
- 0.00
compliance (regulatory policies and program guidelines)

1.1) Conduct stock inventory of all DOH provided oral N:

- RHU Dinas
commodities D:
1) To ensure compliance of health
facilities with regulatory policies and N:
program guidelines 1.2) Establishment of a functional dental clinic (well-maintained
- RHU Dinas
dental facility and equipment) D:

N:
1.3) Monitor RHUs implementation of basic oral health care
- RHU Dinas
services
D:
 2) 100% of outbreak/ epidemiologic investigations conducted
2) To ensure the provision of immediate
investigation to outbreaks in identified N:
population 2.1) Assist in the conduct of rapid health assessments in assigned
- RHU Dinas
areas (during disaster and epidemic) D:

3.1) 95% Obligation Utilization Rate - 0.00

3.1.1) Facilitate processing of documents for obligation including N:

- RHU Dinas
3) To ensure efficient utilization of DOH utilities, fuels, oils, and other office supplies/ expenses D: 2650000
funds
3.2) 75% Disbursement Utilization Rate - 0.00

N:
3.2.1) Facilitate payment for all obligations - RHU Dinas
D:
4.1) 100% of documents/ requests processed within the
- 0.00
prescribed timeline

N:
4) To ensure compliance with cross- 4.1.1) Preparation and processing of various reports - RHU Dinas
cutting requirements based on standard D:
procedures and timelines in accordance to
4.2) 100% of non-conformities responded with RFA with the
ARTA and other relevant laws - 0.00
prescribed timeline

N:
4.2.1) Audit Observations Memorandum (AOM) compliance - RHU Dinas
D:
Average Rating (Support Functions) 0.00
RATING

Final Rating per

Adjectival
Average Rating Function Final Rating
Function Percentage Distribution Rating Remarks
per Function (Average Rating x (i)
(j)
Percentage Distribution)

Strategic Functions 40% 0.00 0.00

Core Functions 50% 0.00 0.00 0.00
Support Functions 10% 0.00 0.00
Prepared by (k): Date: Validated and Approved by (l): Date:

COCO MARTIN 29-Jan-21 AGNES B. FERNANDO, RN, MAN, PhD

Dentist Director III/ Chair, PMT
For PMT use, do not fill-up columns (m) & (n)
Assessed by (m): Date: Final Rating by (n): Date:

DOREEN ANN ARAMBALA AUGUSTO MANOLO G. ALPICHI, MD, MPH

DMO IV OIC - Director III/ PMT Chair
Legend: 1- Quality 2 -Efficiency 3 - Timeliness 4 - Average (100% and above) (70%-99%) (69% - below)
DOH - SPMS Form 1 Document Code:
INDIVIDUAL PERFORMANCE COMMITMENT AND REVIEW (IPCR) Revision No.: 0
Effectivity: July 14, 2020

I, MARIA MERCEDEZ, Nurse I/NDP of Salug, Zamboanga del Norte, commit to deliver and agree to be rated on the attainment of the following targets in accordance with the indicated measures for the period January 1 - December 31, 2021.

Name of Employee: MARIA MERCEDEZ Date: 1/29/2021

NDP/ Nurse I
Approved By:

_________________JANE B. JAUG, MD_____________ Date: January 15, 2021

DMO V

Actual Accomplishment RATING

(e ) (g) Remarks/ Justification of
Division/Unit Accomplishmen
Strategic Goals and Objectives Success Indicators and Target Alloted Budget Unmet Targets
Accountable t Rate
(a) (b) (c ) Actual (use separate sheet if needed)
(d) Raw Data (f) Q E T A
Accomplish (h)
(if applicable) (1) (2) (3) (4)
ment
Strategic Functions
1) 100% of LGUs & other stakeholders provided technical
support on province, city and muncipal-wide health systems
integration

N:
1.1) Assist in the Conduct of Strategic Health Investment Planning
- RHU Salug
Activity (assigned area)
1) Engage LGUs and local stakeholders to D:
support province and city-wide health
systems integration 1.2) Identification, assessment and consolidation of LGU Health N:
- RHU Salug
Investment Needs (sourced out from assigned barangays)
D:

N:
1.3) Generation and consolidation of FHSIS data, LGUHSC data at
- RHU Salug
the Municipal/City Level
D:
Average Rating (Strategic Functions) 0.00
Core Functions
2) 100% of policies and programs with dissemination
2) To ensure that relevant policies, campaigns/ activities conducted
guidelines, and programs are cascaded to
N:
LGUs and other health partners 2.1) Roll-out of DOH Program Policies and Guidelines to
- RHU Salug
barangays and other health partners D:

3) 100% of LGUs and other health partners provided with

technical assistance

N:
3.1) Conduct monitoring of MDA implementation - RHU Salug
D:

3.2) Conduct of RCM activities during disease outbreak response N:

- RHU Salug
immunization

3) To ensure efficacy on the provision of

technical assistance to LGUs and other
 3.2) Conduct of RCM activities during disease outbreak response
- RHU Salug
immunization D:

3.3) Roll-out Health Promotion Activities in assigned areas (act as N:

- RHU Salug
resource person) D:
3) To ensure efficacy on the provision of N:
technical assistance to LGUs and other 3.4) Conduct of Covid-19 surveillance and response activities - RHU Salug
health partners towards the achievement D:
of UHC
3.5) Conducts home visit to households (monitoring of pregnant N:
- RHU Salug
and post-partum mothers) D:

3.6) Assist in the conduct of risks assessment among 20 years old N:

- RHU Salug
and above using the PhilPEN protocol D:
3.7) Facilitate in the conduct of blood donation activities, N:
immunization, medical and dental outreach activities among other - RHU Salug
health services D:
N:
3.8) Conduct of contact tracing activities at the barangays - RHU Salug
D:

4) 100% of required plans and reports submitted to repository

offices within the prescribed timeline

4.1) Preparation of Individual Performance Commitment Review N:

- RHU Salug
Target and Accomplishment Report D:
4) To ensure timely submission of reports/ N:
plans to appropriate repository offices 4.2) Submission of Monthly Accomplishment Report to the HRDU - RHU Salug
based on ARTA D:

4.3) Submission of health status reports of families/ households N:

- RHU Salug
visited D:
4.4) Submission of Quarterly FHSIS Reports (sourced from N:
- RHU Salug
assigned barangays) D:
Average Rating (Core Functions)
Support Functions
1) 100% of health facilities monitored for continuous
- 0.00
compliance (regulatory policies and program guidelines)
1) To ensure compliance of health N:
facilities with regulatory policies and 1.1) Facilitate in the conduct of TB Assessment (site inspection and
- RHU Salug
program guidelines validation) D:
1.2) Conduct stock inventory of all DOH provided essential drugs N:
- RHU Salug
and medicines D:

2) 100% of outbreak/ epidemiologic investigations conducted

2.1) Conduct of malaria case investigation and response (As N:

- RHU Salug
needed) D:
2) To ensure the provision of immediate N:
2.2) Assessment of identified barangays with zero human and
investigation to outbreaks in identified - RHU Salug
animal rabies case D:
population
2) To ensure the provision of immediate
investigation to outbreaks in identified
population
2.3) Assessment of barangays service capability on Aedes-borne N:
- RHU Salug
viral disease program D:
2.4) Assist in the conduct of rapid health assessments in assigned N:
- RHU Salug
barangays (during disaster and epidemic) D:
3.1) 100% of documents/ requests processed within the
3) To ensure compliance with cross- - 0.00
prescribed timeline
cutting requirements based on standard
procedures and timelines in accordance to N:
ARTA and other relevant laws 3.1.1) Preparation and processing of various reports - RHU Salug
D:
Average Rating (Support Functions) #REF!
RATING
Final Rating per
Adjectival
Average Rating Function Final Rating
Function Percentage Distribution Rating Remarks
per Function (Average Rating x (i)
(j)
Percentage Distribution)

Strategic Functions 40% 0.00 0.00

Core Functions 50% 0.00 0.00 0.00
Support Functions 10% 0.00 0.00
Prepared by (k): Date: Validated and Approved by (l): Date:

MARIA MERCEDEZ 14-Jan-21 JANE B. JAUG

NDP - Nurse I DMO V
For PMT use, do not fill-up columns (m) & (n)
Assessed by (m): Date: Final Rating by (n): Date:

SHARON CONCHA AUGUSTO MANOLO G. ALPICHI, MD, MPH

DMO IV OIC - Director III/ PMT Chair
Legend: 1- Quality 2 -Efficiency 3 - Timeliness 4 - Average (100% and above) (70%-99%) (69% - below)
DOH - SPMS Form 1 Document Code:
INDIVIDUAL PERFORMANCE COMMITMENT AND REVIEW (IPCR) Revision No.: 0
Effectivity: July 14, 2020
I, DANNIFA JANE D. TABALOC, Nutritionist Dietician/NDDP of Tampilisan, Liloy, Godod & Salug Zamboanga del Norte, commit to deliver and agree to be rated on the attainment of the following targets in accordance with the indicated measures for the period Ju1y 31 - December
31, 2021.

Name of Employee: DANNIFA JANE D. TABALOC Date: December 31, 2021

NDDP/ Nutritionist Dietician
Approved By:

JANE LECIAS - JAUG, MD Date: December 31, 2021

DMO V

Actual Accomplishment RATING

(e ) (g) Remarks/ Justification of
Division/Unit Accomplishmen
Strategic Goals and Objectives Success Indicators and Target Alloted Budget Unmet Targets
Accountable t Rate
(a) (b) (c ) Actual (use separate sheet if needed)
(d) Raw Data (f) Q E T A
Accomplish (h)
(if applicable) (1) (2) (3) (4)
ment
Strategic Functions
1) 100% of LGUs & other stakeholders provided technical
support on province, city and muncipal-wide health systems
integration

RHU TAMPILISAN, N: 4
1.1) Assist in the Conduct of Strategic Health Investment Planning Assisted all 4 LGU's in Annual
- LILOY, GODOD & 100% 100% N/A 5.00 N/A 5.00
Activity (assigned area) Investment Plan
SALUG D: 4 LGU

1) Engage LGUs and local stakeholders to 1.2) Identification, assessment and consolidation of LGU Health RHU TAMPILISAN, N: 4 Assisted all 4 LGU's on Monthly
support province and city-wide health Investment Needs (sourced out from assigned barangays and/or - LILOY, GODOD & 100% 100% N/A 5.00 N/A 5.00
Investment Needs
systems integration areas) SALUG D: 4 LGU

RHU TAMPILISAN, N: 4
1.3) Development of Local Nutrition Action Plan (assigned Assisted all 4 LGU's on
- LILOY, GODOD & 100% 100% N/A 5.00 N/A 5.00
municipality/ area) Development of LNAP
SALUG D: 4 LGU

1.4) Documentation of good practices, initiatives and indigenous RHU TAMPILISAN, N: 1 Submitted Monthly Narrative
knowledge and practices related to nutrition in assigned areas - LILOY, GODOD & 100% 100% N/A 5.00 N/A 5.00 Reports and Documentation in
(supported by MOVs) SALUG D: 1 the Assigned Area
Average Rating (Strategic Functions) 5.00
Core Functions
2) 100% of policies and programs with dissemination
2) To ensure that relevant policies, campaigns/ activities conducted
guidelines, and programs are cascaded to
RHU TAMPILISAN, N: 20 Nutrition Program Polocies such as:
LGUs and other health partners 2.1) Roll-out of DOH Program Policies and Guidelines to
- LILOY, GODOD & 100% 100% N/A 5.00 N/A 5.00 PIMAM, Breastfeeding Policy, Milk
barangays and other health partners D: 20 Code EO51, FIKD, Asin Law
SALUG

3) 100% of LGUs and other health partners provided with

technical assistance
 N: 4
RHU TAMPILISAN, Assisted in the conduct monitoring of MDA
3.1) Assist in the Conduct monitoring of MDA implementation - LILOY, GODOD & 100% 100% 3.00 3.00 N/A 3.00 Implementation for the Month of July in my 4
assigned areas.
SALUG
D: 4

RHU TAMPILISAN, N: N/A

3.2) Assist in the Conduct of RCM activities during disease
outbreak response immunization
- LILOY, GODOD & N/A N/A N/A N/A N/A N/A N/A
SALUG
D: N/A

N: 20 Acted as a resource person in the

3) To ensure efficacy on the provision of RHU TAMPILISAN,
3.3) Roll-out Health Promotion Activities in assigned areas (act as Promotion of Nutriton Program such as:
technical assistance to LGUs and other - LILOY, GODOD & 100% 100% 3.00 3.00 N/A 3.00 PIMAM, Breastfeeding Policy, Milk Code
health partners towards the achievement resource person) D: 20 EO51, FIKD, Asin Law in the assigned
SALUG
of UHC areas.

RHU TAMPILISAN, N: 4 LGU's Assisted in the conduct of Covid-19

3.4) Assist in the Conduct of Covid-19 surveillance and response
LILOY, GODOD & 100% 100% 3.00 3.00 N/A 3.00 surveillance and response activities during
activities D: 4 LGU's the National Vaccination Day
SALUG

N: 6 Assisted in the conduct of

RHU TAMPILISAN,
3.5) Assist in the conduct of Local Nutrition Committee Meeting at Quarterly Local Nutrition
- LILOY, GODOD & 100% 100% 3.00 3.00 N/A 3.00
the municipal level D: 6 Committee Meeting of my
SALUG
assigned area.
RHU TAMPILISAN, N: 4 LGU's
3.6) Conduct of advocacy activities during the Nutrition month Nutriton Month is Celebrated
- LILOY, GODOD & 100% 100% 3.00 3.00 N/A 3.00
celebration D: 4 LGU's every Month of July.
SALUG

N: 4 LGU's
Conducted in the Management and
RHU TAMPILISAN, Intervention of Identified Children with
3.7) Management and intervention of identified children with Nutritional Deficiencies such as: OPT,
- LILOY, GODOD & 100% 100% 3.00 3.00 N/A 3.00 PIMAM (RUTF, Supplemental Feeding,
nutritional deficiencies (OPT, supplementation, etc)
SALUG D: 4 LGU's Micronutrient Supplementation (Vitamin
A.)

4) 100% of required plans and reports submitted to repository

offices within the prescribed timeline

RHU TAMPILISAN, N: 2 Submitted Semi Annual Accomplishment

4.1) Preparation of Individual Performance Commitment Review
- LILOY, GODOD & 100% 100% 3.00 3.00 3.00 3.00 Report and IPCR Target for July to
Target and Accomplishment Report D: 2 December 2021
4) To ensure timely submission of reports/ SALUG
plans to appropriate repository offices
based on ARTA RHU TAMPILISAN, N: 8 Submission of Quarterly
4.2) Submission of Monthly Accomplishment Report to the HRDU - LILOY, GODOD & 100% 100% 3.00 3.00 3.00 3.00 Accomplishment Report to the
SALUG D: 8 HRDU
RHU TAMPILISAN, N: 8 Submiited Nutritional Status
4.3) Submission of health status reports of malnourished children
- LILOY, GODOD & 100% 100% 3.00 3.00 3.00 3.00 Report of Malnourished Children
on a quarterly basis D: 8
SALUG on a Monthly Basis
Average Rating (Core Functions) 3.00
Support Functions
 1) 100% of health facilities monitored for continuous
- 0.00
compliance (regulatory policies and program guidelines)

N: 4 LGU's
RHU TAMPILISAN, Monitor and evaluated Implementation of
1.1) Monitor and evaluate implementation of barangay nutrition
- LILOY, GODOD & 100% 100% N/A 5.00 5.00 5.00 Barangay Nutrition Plan in 4 assigned
plan (barangay level assessment) Areas
SALUG
D: 4 LGU's
1) To ensure compliance of health
facilities with regulatory policies and
program guidelines

N: 4LGU's Conducted Stock Inventory of all DOH

RHU TAMPILISAN, provided Nutrition and Suplements
1.2) Conduct stock inventory of all DOH provided nutrition and supplies such as: RUTF, Vit. A, Iodized
- LILOY, GODOD & 100% 100% N/A 5.00 5.00 5.00 oil Capsule, Ferrous with follic, Calcium
supplements supplies
SALUG Carb and Salter Weighing Scale and
Wooden Height Borad

D: 4LGU's

2) 100% of outbreak/ epidemiologic investigations conducted

2) To ensure the provision of immediate
investigation to outbreaks in identified
N: 4LGU's
population RHU TAMPILISAN, Assisted in the conduct of Rapid Health
2.1) Assist in the conduct of rapid health assessments in assigned
- LILOY, GODOD & 100% 100% N/A 5.00 5.00 5.00 Assestment in the 3 assigned areas during
barangays (during disaster and epidemic) D: 4LGU's Covid -19 Pandemic
SALUG

3.1) 100% of documents/ requests processed within the

3) To ensure compliance with cross- - 0.00
prescribed timeline
cutting requirements based on standard
Prepared and Processed the
procedures and timelines in accordance to RHU TAMPILISAN, N: 4LGU's various reports of my assigned
ARTA and other relevant laws 3.1.1) Preparation and processing of various reports - LILOY, GODOD & 100% 100% N/A 5.00 5.00 5.00
D: 4LGU's areas such as Deliverables,
SALUG
PIMAM Report and IPCR
Average Rating (Support Functions) 5.00
RATING
Final Rating per
Adjectival
Average Rating Function Final Rating
Function Percentage Distribution Rating Remarks
per Function (Average Rating x (i)
(j)
Percentage Distribution)

Strategic Functions 40% 5.00 2.00

Core Functions 50% 3.00 1.50 4.00 VS VERY SATISFACTORY
Support Functions 10% 5.00 0.50
Prepared by (k): Date: Validated and Approved by (l): Date:

December 31, 2021

December 31, 2021
DANNIFA JANE D. TABALOC, RND JANE LECIAS - JAUG, MD
NDDP - Nutritionist Dietician DMO V
For PMT use, do not fill-up columns (m) & (n)
Assessed by (m): Date: Final Rating by (n): Date:

December 31, 2021

CRISTETA C. LABIANO, RN ELLAINE JEAN J. ERFE, MD AUGUSTO MANOLO G. ALPICHI, MD, MPH
DMO IV DMO IV OIC - Director III/ PMT Chair
Legend: 1- Quality 2 -Efficiency 3 - Timeliness 4 - Average (100% and above) (70%-99%) (69% - below)
DOH - SPMS Form 1 Document Code:
INDIVIDUAL PERFORMANCE COMMITMENT AND REVIEW (IPCR) Revision No.: 0
Effectivity: July 14, 2020

I, TASH AMPING, Pharmacist/PPDP of Salug, Zamboanga del Norte, commit to deliver and agree to be rated on the attainment of the following targets in accordance with the indicated measures for the period January 1 - December 31, 2021.

Name of Employee: TASH AMPING Date: 1/29/2021

PPDP - Pharmacist
Approved By:

_________________JANE B. JAUG, MD_____________ Date: January 29, 2021

DMO V

Actual Accomplishment RATING

(e ) (g) Remarks/ Justification of
Division/Unit Accomplishmen
Strategic Goals and Objectives Success Indicators and Target Alloted Budget Unmet Targets
Accountable t Rate
(a) (b) (c ) Actual (use separate sheet if needed)
(d) Raw Data (f) Q E T A
Accomplish (h)
(if applicable) (1) (2) (3) (4)
ment
Strategic Functions
1) 100% of LGUs & other stakeholders provided technical
support on province, city and muncipal-wide health systems
integration

N:
1.1) Facilitate in the establishment of a functional Supply Chain
- RHU Salug
Management System at the RHU (LGU level)
1) Engage LGUs and local stakeholders to D:
support province and city-wide health
systems integration 1.2) Facilitate in the conduct of facility inventory on a monthly N:
- RHU Salug
basis
D:

N:
1.3) Generation and consolidation of SCM-related data at the
- RHU Salug
municipal level
D:
Average Rating (Strategic Functions) 0.00
Core Functions
2) 100% of policies and programs with dissemination
campaigns/ activities conducted

N:
2.1) Roll-out of DOH Program Policies and Guidelines to
- RHU Salug
barangays and other health partners D:
2) To ensure that relevant policies,
guidelines, and programs are cascaded to
LGUs and other health partners N:
2.2) Disseminates Philippine National Formulary and Anti-
- RHU Salug
microbial resistance updates in assigned municipality (area)
D:

N:
2.3) Community tracking/ education camapaign initiatives at the
- RHU Salug
municipal/city level D:
 3) 100% of LGUs and other health partners provided with
technical assistance

3.1) Conduct of Post Marketing Surveillance activities at the N:

- RHU Salug
municipal level D:
3) To ensure efficacy on the provision of N:
technical assistance to LGUs and other 3.2) Coaching and mentoring among local health facilities on SCM - RHU Salug
health partners towards the achievement D:
of UHC
3.3) Roll-out Health Promotion Activities in assigned areas (act as N:
- RHU Salug
resource person) D:

3.4) Capacitate/train LGU staff on Supply Chain Management N:

- RHU Salug
related protocols, updates, and/or guidelines D:

4) 100% of required plans and reports submitted to repository

offices within the prescribed timeline

4.1) Preparation of Individual Performance Commitment Review N:

- RHU Salug
Target and Accomplishment Report D:
4) To ensure timely submission of reports/
plans to appropriate repository offices
based on ARTA N:
4.2) Submission of Monthly Accomplishment Report to the HRDU - RHU Salug
D:

4.3) Submission of monthly status reports of essential drugs and N:

- RHU Salug
other commodities (tracking of stock-outs in facilities) D:
Average Rating (Core Functions)
Support Functions
1) 100% of health facilities monitored for continuous
- 0.00
compliance (regulatory policies and program guidelines)
1) To ensure compliance of health N:
facilities with regulatory policies and 1.1) Conduct stock inventory of all DOH provided essential drugs
- RHU Salug
program guidelines and medicines D:
1.2) Conducts health facility visits (monitoring of compliance to the N:
- RHU Salug
program/ Pharmacovigilance) D:

2) To ensure the provision of immediate 2) 100% of outbreak/ epidemiologic investigations conducted

investigation to outbreaks in identified
population 2.1) Assist in the conduct of rapid health assessments in assigned N:
- RHU Salug
barangays (during disaster and epidemic) D:
3.1) 100% of documents/ requests processed within the
3) To ensure compliance with cross- - 0.00
prescribed timeline
cutting requirements based on standard
procedures and timelines in accordance to N:
ARTA and other relevant laws 3.1.1) Preparation and processing of various reports - RHU Salug
D:
Average Rating (Support Functions) #REF!
RATING
Final Rating per
Adjectival
Average Rating Function Final Rating
Function Percentage Distribution Rating Remarks
per Function (Average Rating x (i)
(j)
Percentage Distribution)

Strategic Functions 40% 0.00 0.00

Core Functions 50% 0.00 0.00 0.00
Support Functions 10% 0.00 0.00
Prepared by (k): Date: Validated and Approved by (l): Date:

TASH AMPING 14-Jan-21 JANE B. JAUG

PDPP - Pharmacist DMO V
For PMT use, do not fill-up columns (m) & (n)
Assessed by (m): Date: Final Rating by (n): Date:

SHARON CONCHA AUGUSTO MANOLO G. ALPICHI, MD, MPH

DMO IV OIC - Director III/ PMT Chair
Legend: 1- Quality 2 -Efficiency 3 - Timeliness 4 - Average (100% and above) (70%-99%) (69% - below)
DOH - SPMS Form 1 Document Code:
INDIVIDUAL PERFORMANCE COMMITMENT AND REVIEW (IPCR) Revision No.: 0
Effectivity: July 14, 2020

I, MARIA MERCEDEZ, Nurse I/NDP of Salug, Zamboanga del Norte, commit to deliver and agree to be rated on the attainment of the following targets in accordance with the indicated measures for the period January 1 - December 31, 2021.

Name of Employee: MARIA MERCEDEZ Date: 1/29/2021

NDP/ Nurse I
Approved By:

_________________JANE B. JAUG, MD_____________ Date: January 29, 2021

DMO V

Actual Accomplishment RATING

(e ) (g) Remarks/ Justification of
Division/Unit Accomplishmen
Strategic Goals and Objectives Success Indicators and Target Alloted Budget Unmet Targets
Accountable t Rate
(a) (b) (c ) Actual (use separate sheet if needed)
(d) Raw Data (f) Q E T A
Accomplish (h)
(if applicable) (1) (2) (3) (4)
ment
Strategic Functions
1) 100% of LGUs & other stakeholders provided technical
support on province, city and muncipal-wide health systems
integration

1) Engage LGUs and local stakeholders to N:

1.1) Assist in the Conduct of Strategic Health Investment Planning
support province and city-wide health - RHU Salug
Activity (assigned area)
systems integration D:

1.2) Identification, assessment and consolidation of LGU Health N:

- RHU Salug
Investment Needs (laboratory deficiencies)
D:
Average Rating (Strategic Functions) 0.00
Core Functions
2) 100% of policies and programs with dissemination
2) To ensure that relevant policies, campaigns/ activities conducted
guidelines, and programs are cascaded to
N:
LGUs and other health partners 2.1) Roll-out of DOH Program Policies and Guidelines to
- RHU Salug
barangays and other health partners D:

3) 100% of LGUs and other health partners provided with

technical assistance

N:
3.1) Assist in the Conduct monitoring of MDA implementation - RHU Salug
D:

3.2) Assist in the Conduct of RCM activities during disease N:

- RHU Salug
outbreak response immunization D:

3.3) Roll-out Health Promotion Activities in assigned areas (act as N:

- RHU Salug
3) To ensure efficacy on the provision of resource person) D:
technical assistance to LGUs and other
health partners towards the achievement
of UHC
3) To ensure efficacy on the provision of
technical assistance to LGUs and other
health partners towards the achievement N:
3.4) Assist in the Conduct of Covid-19 surveillance and response
of UHC - RHU Salug
activities D:

3.5) Laboratory specimens collected, examined and timely N:

- RHU Salug
processed D:
3.6) Facilitate in the conduct of blood donation activities, N:
immunization, medical and dental outreach activities among other - RHU Salug
health services D:

3.7) Assist in the Conduct of contact tracing activities at the N:

- RHU Salug
barangays D:

4) 100% of required plans and reports submitted to repository

offices within the prescribed timeline

4.1) Preparation of Individual Performance Commitment Review N:

- RHU Salug
Target and Accomplishment Report D:
4) To ensure timely submission of reports/
plans to appropriate repository offices
based on ARTA N:
4.2) Submission of Monthly Accomplishment Report to the HRDU - RHU Salug
D:

4.3) Submission of blood utilization report, and other laboratory N:

- RHU Salug
related reports to PDOHO and CHD on a quarterly basis D:
Average Rating (Core Functions)
Support Functions
1) 100% of health facilities monitored for continuous
- 0.00
compliance (regulatory policies and program guidelines)

1.1) Facilitate in the conduct of TB Assessment (site inspection and N:

1) To ensure compliance of health - RHU Salug
validation) D:
facilities with regulatory policies and
program guidelines N:
1.2) Monitor infection control and disposal of biological and
- RHU Salug
chemical substances of barangays D:
1.3) Conduct stock inventory of all DOH provided for laboratory N:
- RHU Salug
use D:

2) 100% of outbreak/ epidemiologic investigations conducted

2.1) Conduct of malaria case investigation and response (As N:

- RHU Salug
needed) D:
2) To ensure the provision of immediate N:
2.2) Assessment of identified barangays with zero human and
investigation to outbreaks in identified - RHU Salug
animal rabies case D:
population
2.3) Assessment of barangays service capability on Aedes-borne N:
- RHU Salug
viral disease program D:
2.4) Assist in the conduct of rapid health assessments in assigned N:
- RHU Salug
barangays (during disaster and epidemic) D:
3.1) 100% of documents/ requests processed within the
3) To ensure compliance with cross- - 0.00
prescribed timeline
cutting requirements based on standard
procedures and timelines in accordance to
ARTA and other relevant laws
3) To ensure compliance with cross-
cutting requirements based on standard
procedures and timelines in accordance to N:
ARTA and other relevant laws 3.1.1) Preparation and processing of various reports - RHU Salug
D:
Average Rating (Support Functions) #REF!
RATING
Final Rating per
Adjectival
Average Rating Function Final Rating
Function Percentage Distribution Rating Remarks
per Function (Average Rating x (i)
(j)
Percentage Distribution)
Strategic Functions 40% 0.00 0.00
Core Functions 50% 0.00 0.00 0.00
Support Functions 10% 0.00 0.00
Prepared by (k): Date: Validated and Approved by (l): Date:

MARIA MERCEDEZ 29-Jan-21 JANE B. JAUG

MTDP - Medtech DMO V
For PMT use, do not fill-up columns (m) & (n)
Assessed by (m): Date: Final Rating by (n): Date:

SHARON CONCHA AUGUSTO MANOLO G. ALPICHI, MD, MPH

DMO IV OIC - Director III/ PMT Chair
Legend: 1- Quality 2 -Efficiency 3 - Timeliness 4 - Average (100% and above) (70%-99%) (69% - below)
DOH - SPMS Form 1 Document Code:
INDIVIDUAL PERFORMANCE COMMITMENT AND REVIEW (IPCR) Revision No.: 0
Effectivity: July 14, 2020

I, MARIA MERCEDEZ, Physical Therapist (PTDP) of Salug, Zamboanga del Norte, commit to deliver and agree to be rated on the attainment of the following targets in accordance with the indicated measures for the period January 1 - December 31, 2021.

Name of Employee: MARIA MERCEDEZ Date: 1/29/2021

PTDP/ Physical Therapist
Approved By:

_________________JANE B. JAUG, MD_____________ Date: January 15, 2021

DMO V

Actual Accomplishment RATING

(e ) (g) Remarks/ Justification of
Division/Unit Accomplishmen
Strategic Goals and Objectives Success Indicators and Target Alloted Budget Unmet Targets
Accountable t Rate
(a) (b) (c ) Actual (use separate sheet if needed)
(d) Raw Data (f) Q E T A
Accomplish (h)
(if applicable) (1) (2) (3) (4)
ment
Strategic Functions
1) 100% of LGUs & other stakeholders provided technical
support on province, city and muncipal-wide health systems
integration

1) Engage LGUs and local stakeholders to N:

1.1) Assist in the Conduct of Strategic Health Investment Planning
support province and city-wide health - RHU Salug
Activity (assigned area)
systems integration D:

1.2) Identification, assessment and consolidation of LGU Health N:

Investment Needs related to preventive and rehabilatative services - RHU Salug
(sourced out from assigned barangays) D:
Average Rating (Strategic Functions) 0.00
Core Functions
2) 100% of policies and programs with dissemination
2) To ensure that relevant policies, campaigns/ activities conducted
guidelines, and programs are cascaded to
N:
LGUs and other health partners 2.1) Roll-out of DOH Program Policies and Guidelines to
- RHU Salug
barangays and other health partners D:

3) 100% of LGUs and other health partners provided with

technical assistance

N:
3.1) Assist in the Conduct monitoring of MDA implementation - RHU Salug
D:

3.2) Assist in the Conduct of RCM activities during disease N:

- RHU Salug
outbreak response immunization D:

3.3) Roll-out Health Promotion Activities in assigned areas (act as N:

- RHU Salug
3) To ensure efficacy on the provision of resource person) D:
technical assistance to LGUs and other
health partners towards the achievement
of UHC
3) To ensure efficacy on the provision of
technical assistance to LGUs and other
health partners towards the achievement N:
3.4) Assist in the Conduct of Covid-19 surveillance and response
of UHC - RHU Salug
activities D:

3.5) Conducts regular visits to catchment areas for provision of N:

- RHU Salug
preventive and rehabilative services to identified clients D:

3.6) Assist in the conduct of risks assessment among 20 years old N:

- RHU Salug
and above using the PhilPEN protocol D:

3.7) Management of patients with rehabilitative needs re: handles, N:

- RHU Salug
provided intervention and referred D:

4) 100% of required plans and reports submitted to repository

offices within the prescribed timeline

4.1) Preparation of Individual Performance Commitment Review N:

- RHU Salug
Target and Accomplishment Report D:
4) To ensure timely submission of reports/
plans to appropriate repository offices
based on ARTA N:
4.2) Submission of Monthly Accomplishment Report to the HRDU - RHU Salug
D:

4.3) Preparation and Submission of health status reports of patients N:

- RHU Salug
handled & provided interventions and referred D:
Average Rating (Core Functions)
Support Functions
1) 100% of health facilities monitored for continuous
- 0.00
1) To ensure compliance of health compliance (regulatory policies and program guidelines)
facilities with regulatory policies and
1.1) Monitor implementation of preventive and rehabilitative N:
program guidelines
- RHU Salug
programs at the barangay level (or areas covered) D:

2) To ensure the provision of immediate 2) 100% of outbreak/ epidemiologic investigations conducted

investigation to outbreaks in identified
population 2.1) Assist in the conduct of rapid health assessments in assigned N:
- RHU Salug
barangays (during disaster and epidemic) D:
3.1) 100% of documents/ requests processed within the
3) To ensure compliance with cross- - 0.00
prescribed timeline
cutting requirements based on standard
procedures and timelines in accordance to N:
ARTA and other relevant laws 3.1.1) Preparation and processing of various reports - RHU Salug
D:
Average Rating (Support Functions) #REF!
RATING
Final Rating per
Adjectival
Average Rating Function Final Rating
Function Percentage Distribution Rating Remarks
per Function (Average Rating x (i)
(j)
Percentage Distribution)

Strategic Functions 40% 0.00 0.00

Core Functions 50% 0.00 0.00 0.00
Support Functions 10% 0.00 0.00
Prepared by (k): Date: Validated and Approved by (l): Date:

MARIA MERCEDEZ 14-Jan-21 JANE B. JAUG

PTDP- Physical Therapist DMO V
For PMT use, do not fill-up columns (m) & (n)
Assessed by (m): Date: Final Rating by (n): Date:

SHARON CONCHA AUGUSTO MANOLO G. ALPICHI, MD, MPH

DMO IV OIC - Director III/ PMT Chair
Legend: 1- Quality 2 -Efficiency 3 - Timeliness 4 - Average (100% and above) (70%-99%) (69% - below)
DOH - SPMS Form 1 Document Code:
INDIVIDUAL PERFORMANCE COMMITMENT AND REVIEW (IPCR) Revision No.: 0
Effectivity: July 14, 2020

I, MARIA MERCEDEZ, Midwife/RHMPP of Salug, Zamboanga del Norte, commit to deliver and agree to be rated on the attainment of the following targets in accordance with the indicated measures for the period January 1 - December 31, 2021.

Name of Employee: MARIA MERCEDEZ Date: 1/29/2021

RHMPP/ Midwife
Approved By:

_________________JANE B. JAUG, MD_____________ Date: January 29, 2021

DMO V

Actual Accomplishment RATING

(e ) (g) Remarks/ Justification of
Division/Unit Accomplishmen
Strategic Goals and Objectives Success Indicators and Target Alloted Budget Unmet Targets
Accountable t Rate
(a) (b) (c ) Actual (use separate sheet if needed)
(d) Raw Data (f) Q E T A
Accomplish (h)
(if applicable) (1) (2) (3) (4)
ment
Strategic Functions
1) 100% of LGUs & other stakeholders provided technical
support on province, city and muncipal-wide health systems
integration

N:
1.1) Assist in the Conduct of Strategic Health Investment Planning
- RHU Salug
Activity (assigned area)
D:
1) Engage LGUs and local stakeholders to
1.2) Identification, assessment and consolidation of unmet needs for N:
support province and city-wide health - RHU Salug
systems integration modern family planning (sourced out from assigned barangays)
D:

1.3) Pregnant women provided direct maternal and child care N:

- RHU Salug
services (pre and post partum, during deliveries, among others) D:
N:
1.4) Families (mother/father) provided counseling services - RHU Salug
D:
Average Rating (Strategic Functions) 0.00
Core Functions
2) 100% of policies and programs with dissemination
2) To ensure that relevant policies, campaigns/ activities conducted
guidelines, and programs are cascaded to
N:
LGUs and other health partners 2.1) Roll-out of DOH Program Policies and Guidelines to
- RHU Salug
barangays and other health partners D:

3) 100% of LGUs and other health partners provided with

technical assistance

N:
3.1) Assist in the Conduct monitoring of MDA implementation - RHU Salug
D:
 3.2) Assist in the Conduct of RCM activities during disease N:
- RHU Salug
outbreak response immunization D:

3.3) Roll-out Health Promotion Activities in assigned areas (act as N:

- RHU Salug
resource person) D:
3) To ensure efficacy on the provision of N:
technical assistance to LGUs and other 3.4) Assist in the Conduct of Covid-19 surveillance and response
- RHU Salug
health partners towards the achievement activities D:
of UHC
3.5) Conducts home visit to households (monitoring of pregnant N:
- RHU Salug
and post-partum mothers) D:

3.6) Assist in the conduct of risks assessment among 20 years old N:

- RHU Salug
and above using the PhilPEN protocol D:
3.7) Facilitate in the conduct of blood donation activities, N:
immunization, medical and dental outreach activities among other - RHU Salug
health services D:

3.8) Assist in the Conduct of contact tracing activities at the N:

- RHU Salug
barangays D:

4) 100% of required plans and reports submitted to repository

offices within the prescribed timeline

4.1) Preparation of Individual Performance Commitment Review N:

- RHU Salug
Target and Accomplishment Report D:
4) To ensure timely submission of reports/ N:
plans to appropriate repository offices 4.2) Submission of Monthly Accomplishment Report to the HRDU - RHU Salug
based on ARTA D:

4.3) Submission of health status reports of families/ households N:

- RHU Salug
visited D:
4.4) Submission of Quarterly FHSIS Reports (sourced from N:
- RHU Salug
assigned barangays) D:
Average Rating (Core Functions)
Support Functions
1) 100% of health facilities monitored for continuous
- 0.00
1) To ensure compliance of health compliance (regulatory policies and program guidelines)
facilities with regulatory policies and
1.1) Conduct stock inventory of all DOH provided essential drugs N:
program guidelines
- RHU Salug
and medicines D:

2) To ensure the provision of immediate 2) 100% of outbreak/ epidemiologic investigations conducted

investigation to outbreaks in identified
population 2.1) Assist in the conduct of rapid health assessments in assigned N:
- RHU Salug
barangays (during disaster and epidemic) D:
3.1) 100% of documents/ requests processed within the
3) To ensure compliance with cross- - 0.00
prescribed timeline
cutting requirements based on standard
procedures and timelines in accordance to
ARTA and other relevant laws
3) To ensure compliance with cross-
cutting requirements based on standard
procedures and timelines in accordance to N:
ARTA and other relevant laws 3.1.1) Preparation and processing of various reports - RHU Salug
D:
Average Rating (Support Functions) #REF!
RATING
Final Rating per
Adjectival
Average Rating Function Final Rating
Function Percentage Distribution Rating Remarks
per Function (Average Rating x (i)
(j)
Percentage Distribution)
Strategic Functions 40% 0.00 0.00
Core Functions 50% 0.00 0.00 0.00
Support Functions 10% 0.00 0.00
Prepared by (k): Date: Validated and Approved by (l): Date:

MARIA MERCEDEZ 29-Jan-21 JANE B. JAUG

RHMPP - Midwife DMO V
For PMT use, do not fill-up columns (m) & (n)
Assessed by (m): Date: Final Rating by (n): Date:

SHARON CONCHA AUGUSTO MANOLO G. ALPICHI, MD, MPH

DMO IV OIC - Director III/ PMT Chair
Legend: 1- Quality 2 -Efficiency 3 - Timeliness 4 - Average (100% and above) (70%-99%) (69% - below)
DOH - SPMS Form 1 Document Code:
INDIVIDUAL PERFORMANCE COMMITMENT AND REVIEW (IPCR) Revision No.: 0
Effectivity: July 14, 2020

I, NIMFA CHUKCHUK, AO I, commit to deliver and agree to be rated on the attainment of the following targets in accordance with the indicated measures for the period January 1 - December 31, 2021.

Name of Employee: NIMFA CHUKCHUK Date: 1/14/2021

AO I
Approved By:

JANE B. JAUG, MD Date: January 15, 2021

DMO V

Actual Accomplishment RATING

(e ) (g) Remarks/ Justification of
Division/Unit Accomplishmen
Strategic Goals and Objectives Success Indicators and Target Alloted Budget Unmet Targets
Accountable t Rate
(a) (b) (c ) Actual (use separate sheet if needed)
(d) Raw Data (f) Q E T A
Accomplish (h)
(if applicable) (1) (2) (3) (4)
ment
Strategic Functions

1) 100% of policies and program with dissemination

campaigns/ activities conducted

1) To ensure that relevant policies, 1.1) Assist in the Conduct of PDOHO Performance Management N:
guidelines, and programs are cascaded to Review - PDOHO
LGUs and other health partners D:

N:
1.2) Assist in the Roll-out/ cascading of DOH Program Policies and
- PDOHO
Guidelines to LGUs and other health partners
D:

2.1) 95% Obligation Utilization Rate - 0.00

2.1.1) Facilitate processing of documents for obligation including N:

2,650,000.00 PDOHO
2) To ensure efficient utilization of DOH utilities, fuels, oils, and other office supplies/ expenses D: 2650000
funds
2.2) 75% Disbursement Utilization Rate - 0.00

N:
2.2.1) Facilitate payment for all obligations - PDOHO
D:
Average Rating (Strategic Functions) 0.00
Core Functions
3.1) 100% of documents/ requests processed within the
prescribed timeline
3) To ensure compliance with cross- N:
cutting requirements based on standard 3.1.1) Procurement of Office and Janitorial Supplies, IT Equipment
150,000.00 PDOHO
procedures and timelines in accordance to and other office supplies D:
ARTA and other relevant laws
3) To ensure compliance with cross-
cutting requirements based on standard
procedures and timelines in accordance to
ARTA and other relevant laws

Preparation and processing of various reports;

N:
3.1.2) Procurement Requests (PRs) - PDOHO
D:
N:
3.1.3) Daily Time Records (DTRs) - PDOHO
D:
N:
3.1.4) Incoming and outgoing communications - PDOHO
D:
N:
3.1.5) Reimbursement reports/ documents - PDOHO
D:
N:
3.1.6) Customer Satisfaction Survey Report - PDOHO
D:
N:
3.1.7) Advisories/ memos/ others - PDOHO
D:
N:
3.1.8) Leave Applications - PDOHO
D:
N:
…..cont...To ensure compliance with 3.1.9) Certificate of Appearance - PDOHO
cross-cutting requirements based on D:
standard procedures and timelines in
accordance to ARTA and other relevant N:
laws 3.1.10) Statement of Accounts (SOA) from provincial suppliers - PDOHO
D:
N:
3.1.11) Submission of IPCR/DPCR to Regional Office - PDOHO
D:

3.1.12) Performance Evaluation Result of Suppliers, Contractuals, N:

- PDOHO
and HRH D:
N:
3.1.13) Submission of PDS of Regular Employees - PDOHO
D:
N:
3.1.14) Inventory of Commodities/Stocks - PDOHO
D:
N:
3.1.15) Vehicle maintenance (repairs and replacement of parts) - PDOHO
D:

3.1.16) Property Transfer Receipt (PTR)/ RIS/PAR/Stock Card/ Bin N:

- PDOHO
Card/ Others D:
N:
3.1.17) Payment for Communication, rental and other utilities - PDOHO
3.1.17) Payment for Communication, rental and other utilities - PDOHO
D:
Average Rating (Core Functions)
Support Functions

4) 100% of LGUs & other stakeholders provided technical

4) Engage LGUs and local stakeholders to support on province & city-wide health systems integration
support province and city-wide health
systems integration N:
4.1) Provincial Consolidation of LGU Health Investment Needs - PDOHO
D:
5) 100% of required plans and reports submitted to repository
offices within the prescribed timeline
N:
5.1) Preparation and submission of 2022 WFP and PPMP - PDOHO
D:

5.2) Preparation of Individual Performance Commitment Review N:

- PDOHO
Target and Accomplishment Report D:
N:
5.3) Preparation and submission of PBUR and MR Reports - PDOHO
D:
N:
5) To ensure timely submission of reports/ 5.4) Submission of Assessment Tool for LHS - PDOHO
plans to appropriate repository offices D:
based on ARTA
N:
5.5) Submission of LIPH/AOP (validated and appraised) - PDOHO
D:

5.6) Submission of Consolidated Provincial Health Investment N:

- PDOHO
Needs D:

5.7) Submission of Quarterly FHSIS Reports (municipal and N:

- PDOHO
provincial) --- with Provincial Consolidation D:

5.8) Submission of malaria weekly and quarterly morbidity report N:

- PDOHO
(MCEP report) D:
Average Rating (Support Functions) 0.00
RATING

Final Rating per Function Adjectival

Average Rating Final Rating
Function Percentage Distribution (Average Rating x Rating Remarks
per Function Percentage Distribution) (i)
(j)

Strategic Functions 40% 0.00 0.00

Core Functions 50% 0.00 0.00 0.00
Support Functions 10% 0.00 0.00
Prepared by (k): Date: Validated and Approved by (l): Date:

NIMFA CHUKCHUK 14-Jan-21 JANE B. JAUG

AO I DMO V
For PMT use, do not fill-up columns (m) & (n)
Assessed by (m): Date: Final Rating by (n): Date:

CHARLOU E. PELIGRO
JOSHUA G. BRILLANTES, MD, MPH, CESE
DMO IV/ HEAD, PLANNING Director III/ Chair, Regional Performance Management Team
Legend: 1- Quality 2 -Efficiency 3 - Timeliness 4 - Average (100% and above) (70%-99%) (69% - below)