Republic of the Philippines

Department of Education
Region VI - Western Visayas
Division of Silay City
DOÑA MONTSERRAT LOPEZ MEMORIAL HIGH SCHOOL SHS
City of Silay

EMPLOYEE FEEDBACK FORM

RATING PERIOD: SY: 2017 - 2018

FINAL PERFORMANCE RATING

ACCOMPLISHMENTS OF KRAs and OBJECTIVES

SUMMARY OF RATINGS FOR DISCUSSION
Name: Name of Superior: DR. CATHERINE R. APUSAGA
Signature: Signature:
Date: Date:

STRENGHTS DEVELOPMENT NEEDS ACTION PLAN TIMELINE RESOURCE NEEDED

1. Prepared lesson plan/daily logs of Accomplished this if score is Accomplished this if score is Accomplished this if score is Accomplished this if
activities including adequate and below 3 in a specific objectiv below 3 in a specific objectiv below 3 in a specific objectiv score is below 3 in a
update instructional materials. per KRA per KRA per KRA specific objectiv per KRA

Accomplished this if score is Accomplished this if score is Accomplished this if score is Accomplished this if
2. Delivered lesson plan in accordance below 3 in a specific objectiv below 3 in a specific objectiv below 3 in a specific objectiv score is below 3 in a
with the expected outcomes. per KRA per KRA per KRA specific objectiv per KRA
3.Provided interventions/activities for Accomplished this if score is
students at risk/slow learners and below 3 in a specific objectiv
enrichment activities for the fast per KRA
learners.
4.Monitored, updated and
maintained students’
progress/outcomes.
Accomplished this if score is
5. Maintianed updated students’ below 3 in a specific objectiv
school records. per KRA
Accomplished this if score is
6. Conduct PTA meetings to report below 3 in a specific objectiv
students’ progress in the school year. per KRA
7. Supported program and projects of Accomplished this if score is
Government Organizations and Non- below 3 in a specific objectiv
Government Organizations. per KRA
8. Participated in Community activities Accomplished this if score is
like Clean-Up Drive (Coastal areas, below 3 in a specific objectiv
Highland areas, Cemetery areas, etc.) per KRA
9. Undertaken/Initiated
projects/ events/ activities
with external funding/
sponsorship.
Accomplished this if score is
below 3 in a specific objectiv
per KRA
To provide learning materials
and activities fitted to the
needs of students especially
slow learners to improve MPS
and other related students’
outcomes.
Accomplished this if score is
below 3 in a specific objectiv
per KRA
Accomplished this if score is
below 3 in a specific objectiv
per KRA
Accomplished this if score is
below 3 in a specific objectiv
per KRA
Accomplished this if score is
below 3 in a specific objectiv
per KRA
To take part/ embark on
community activities as a
Chairman and submit
accomplishment report ahead
of time with no corrections.
Accomplished this if score is Accomplished this if
below 3 in a specific objectiv score is below 3 in a
per KRA specific objectiv per KRA
Activity sheets,
June 2017 to April 2018 Intervention plan and
activities, Students’
progress form, Parents’
conference notebook
Accomplished this if score is Accomplished this if
below 3 in a specific objectiv score is below 3 in a
per KRA specific objectiv per KRA
Accomplished this if score is Accomplished this if
below 3 in a specific objectiv score is below 3 in a
per KRA specific objectiv per KRA
Accomplished this if score is Accomplished this if
below 3 in a specific objectiv score is below 3 in a
per KRA specific objectiv per KRA
Accomplished this if score is Accomplished this if
below 3 in a specific objectiv score is below 3 in a
per KRA specific objectiv per KRA
Community activity
June 2017 to April 2018
plan
 Accomplished this if score is Accomplished this if score is Accomplished this if score is Accomplished this if
10. Attended faculty meeting and In- below 3 in a specific objectiv below 3 in a specific objectiv below 3 in a specific objectiv score is below 3 in a
Service Training/Seminar. per KRA per KRA per KRA specific objectiv per KRA

11. Served as trainer/ To participate in school Accomplishment report,

coach / subject coordinator activities as trainer/ coach and June 2017 to April 2018 school activity as
and other related tasks . carry out other related tasks. trainer / coach

Accomplished this if score is Accomplished this if score is Accomplished this if score is Accomplished this if
12. Earned units in Graduate below 3 in a specific objectiv below 3 in a specific objectiv below 3 in a specific objectiv score is below 3 in a
studies/National Certificate per KRA per KRA per KRA specific objectiv per KRA

Employee Feedback

I agree and undertake to observe and sustain my students’ progress in their academics, take part on community activities and participate in school
activities as trainer / coach.

DR. CATHERINE R. APUSAGA

Rater Ratee
Serve as a sample

Serve as a sample
Serve as a sample