COM-SPMS FORM NO.

3 ( IPCR)
CITY OF MANILA -STRATEGIC PERFORMANCE MANAGEMENT SYSTEM (COM-SPMS) TEMPLATE
INDIVIDUAL PERFORMANCE COMMITMENT AND REVIEW IPCR)
I, _________________________________________ (Name,)
STAFF NURSE ( NURSE I, II , III )
(Position/Designation),
NURSING SERVICE , (Division)
_______________________________________________( Department), commit to deliver and agree to be rated on the attainment of the following targets in accordance with the indicated
measures for the period ______________________________to ___________________________, 20____.
Signature
Date of Signing (Beginning of the Rating Period):
________________________
APPROVED BY:

REVIEWED BY

Immediate Supervisor

Department Head

Date

Date
RATING SCALE
5 - Outstanding
4- Very Satisfactory
3 - Satisfactory
2 -Unsatisfactory
1- Poor

LEGEND
Q- Quality
E- Efficiency
T-Timeliness
A- Average

Major Final Output( MFO)

Success Indicators

( please add rows if necessary)

(Targets + Measures)

MFO 1.
Basic and Specialized Medical Services
Patient Care Management

100% of patients within:

For minimal to moderately ill: 15 to 30 minutes
For critically ill: 1 to 2 hours
100% of patients given quality nursing care within
the shift
100% of patients health condition and nursing
care
documented within the shift
100% of patients referral coordinated within the
shift

REMARKS

RATING
Actual Accomplishments
Q

MFO 2.
Regulatory Services for Health Products,
Devices, Equipment and Facilities

100% health teachings to patients provided within

the shift

100% of medical equipment and facilities handled

and maintained daily
100% of medicines administered to patients with
prescription and recorded to patients chart per
shift
100% of medicines and supplies used to patients
reflected in the availment form per shift
conducted daily inventory of medicines, supplies
and equipment.

MFO 3.
General Administrative Support Services
(GASS)
Record Management

Admitting & Discharge

Dietary Services

Philhealth Services

Housekeepig

MFO 4.
Support to Operations

100% completeness of patients chart ensured per

shift
100% of admitted and discharged patients
properly
recorded in the logbooks per shift
100% of patients diet list submitted daily
100% of newly admitted patients diet and changes
in patients diet informed per shift
100% of patients classification facilitated per shift
100% of clinical area cleaned and maintained per
shift
Conduct concurrent and terminal disinfection per
shift
100% of assistance provide to departments
under the City Government of Manila and other
agencies
Health Activities of the City
Socio-cultural Activities
Disaster management
Medical Mission

Working Committees of the Hospital

Management

FINAL AVERAGE RATING

ADJECTIVAL RATING
DISCUSSED WITH :

FINAL RATING BY:

ASSESSED BY :

Department Head

Immediate Supervisor
I certify that I discussed my assessment of the performance with the
employee .

Name & Signature of Ratee

Position :
Date :

Name & Signature of Rater

Position :
Date :

Name & Signature of Department Head

Position :
Date :