IPCRF DENTAL AIDE

1. INDIVIDUAL PERFORMANCE COMMITMENT AND REVIEW FORM
Name of Employee: ________ Name of Rater: ______________________________
Position: Position: _______________________
Review Period: __________ Date of Review: ____________________________
Bureau / Center / Service / Division
TO BE FILLED IN DURING PLANNING
MOF
Key Result Areas
(KRAs)
OBJECTIVES TIMELINE
Weight
per
KRA
PERFORMANCE
INDICATORS (Quality,
Efficiency, Timeliness)
TO BE FILLED DURING EVALUATION
Actual Result
RAT
ING
SCO
RE
Q E T
A. HEALTH AND
NUTRITION
SERVICE
DEVELOPMENT
IN PUBLIC
ELEMENTARY &
SECONDARY
SCHOOLS
Conducted oral
examination /
Inspection /
Prohylaxis
50%
Jan-Mar / June-
Dec
5
Pre-elementary pupils - 90%
June-Aug. 5 Grades I-III Pupils – 85%
Sept-Mar. 3 Grade IV-VI Pupils – 70%
Sept-Mar. 2 First Year Students – 60%
Year Round 1 Teachers & NTP – 60%
June-March
.
5
50% of Pupils orally
examined for Oral treatment
June-Dec. 1
50% of pupils with dental
ailments for treatment
Year Round 2
50% of teachers and non-
teaching personnel with
dental ailments of oral
prophylaxis
Health
Education /
Task
Year Round 2
20-30% of classes in schools
visited
Year Round 2
Served as speaker in health
activities
Year Round 2
Expansion of BSBF, EHCP,
other programs & projects
Treatment /
Referrals
Conducted
Year Round 5
Pre-elem – 80% of pupils
with dental ailments
Year Round 5
Grade I – III pupils – 70% of
pupils with Dental Ailments
EMERSON B. BALDEO
DENTAL AIDE
JAN. TO DEC. 2016

2. TO BE FILLED IN DURING PLANNING
MOF
Key Result Areas
(KRAs)
OBJECTIVES TIMELINE
Weight
per
KRA
PERFORMANCE
INDICATORS (Quality,
Efficiency, Timeliness)
TO BE FILLED DURING EVALUATION
Actual Result
RAT
ING
SCO
RE
Q E T
Year Round 1
Grade IV-VI pupils – 60# of
pupils with dental ailments
Year Round 2
1st Year Students-50% of
pupils with dental ailments
Year Round 1
2nd – 4th Year Student – 50%
of pupils with dental ailments
Year Round 1
Teaching & non-teaching
personnel – 50% of teachers
with dental ailments.
Once 3 weeks
for 10 months
2
Weekly Sodium Fluoride
Mouth rinsing of 90% of
Grade I-VI pupils
B. DISTRIBUTION
OF MEDICINES
AND SUPPLIES
Made available
quality
Medicines /
Supplies
10%
2nd Quarter 3
Individual Dental Health
Cards (Elem.)
2nd Quarter 3
Individual Dental Health
Cards (Sec.)
2nd Quarter 2 T/NTP Dental Health Cards
2nd Quarter 2
Sodium Fluoride powder,
dental anesthesia Disposable
dental needles, etc.
C. MONITORING /
SUPERVISORY
EVALUATION
Monitored /
supervised /
Evaluated
implementation of
health & nutrition
programs &
activities &
maintenance of
safe secure &
healthy school
10%
Year Round 5
Maintenance of sale,
healthful & sanitary school
canteen
Year Round 5
Supervised the maintenance
of safe, Healthful & sanitary
conditions of the school
facilities

3. TO BE FILLED IN DURING PLANNING
MOF
Key Result Areas
(KRAs)
OBJECTIVES TIMELINE
Weight
per
KRA
PERFORMANCE
INDICATORS (Quality,
Efficiency, Timeliness)
TO BE FILLED DURING EVALUATION
Actual Result
RAT
ING
SCO
RE
Q E T
environment.
D. HUMAN
RESOURCE
DEVELOPMENT
Attended /
Facilitated
linkages with
other
stakeholders
10%
Year Round 5
Attendance to:
Monthly meetings /
conferences of School Health
Personnel
Year Round 5
Training of teachers on
current health & nutrition
programs & projects
E. LINKAGES
Initiated
linkages with
Other
Stakeholders
10%
Year Round 4
School-Community Health
Council Organized /
reactivated
2
Attendance to GO’s and
NGO’s Assemblies /
meetings / conferences
As necessary 2
Acted as Technical Working
Group Member in various
Nutrition Programs & Projects
of other agencies
Year Round 2
Sourcing of funds / mobilizing
LGUs, NGO’s and other GO’s
for: Provision of medicines,
health services and
equipment to schools /
personnel
F. RECORDING
AND
REPORTING
Submitted
Monthly /
August
10%
March / as 10 Submission of monthly / bi-

4. necessary monthly accomplishment
reports; as necessary for
some programs and projects
OVERALL RATING FOR
ACCOMPLISHMENT
_________________________ _____________________________
Rater Ratee
VRENELI M. MALE OVERALL RATING FOR ACCOMPLISHMENT
Chief SGOD

5. PART III: SUMMARY OF RATINGS FOR DISCUSSION
Final Performance Results Rating Adjectival Rating
Accomplishment of KRAs and Objectives
Rater- Ratee Agreement
Signature: Signature:
Date: Date:
PART IV: DEVELOPMENT PLANS
STRENGTHS
DEVELOPMENT
NEEDS
ACTION PLAN
( Recommended
Developmental Intervention)
Timeline
Resources Needed
_________________________________ _________________________________
Rater Ratee