Name of Employee: MARCIANA F. DONGUIZ Name of Rater: LETICIA S.

SALDO
Position: Teacher III Position: OIC - Principal
Review Period: Date of Review:
OFFICE: Department of Education / CAMBALY NATIONAL HIGH SCHOOL
TO BE FILLED IN DURING PLANNING TO BE FILLED DURING EVALUATION
Weight PERFORMANCE INDICATORS ACTUAL
MFOs KRAs OBJECTIVES TIMELINE RATING SCORE
per KRA Quality Efficiency Timeliness RESULTS
Q E T Ave
5- Outstanding, Submitted
1. Teaching 1. Prepared well-constructed 15% The teacher has met five evidence one day before
Learning lesson plans (LP) daily lesson characteristics of an LP/DLL execution of the lesson
Process log (DLL) reflecting the
4- Very Satisfactory.
(30 %) following characteristics: *If the teacher has not met
Five parts the five characteristics, the Submitted evidence in the
a. Objective is SMART, rater would deduct points morning before the first
based on the desired period.
learning competencies 3- Satisfactory. Submitted
b. It has adequate and evidence after the first
appropriate period.
instructional materials
2- Unsatisfactory.
c. Develop
HigherOrderThinking Submitted evidence 1 day
Skills (HOTS) after the execution of the
d. Developing the 21st lesson
Century Skills 1-Poor. Submitted
e. Teachers Journal evidence 2 or more days
after the execution of the
lesson
2. Facilitated learning in the
school as shown by: 15% The teacher has
a. Teaching methods, accomplished all the 5-Outstanding. The teacher
interactive and indicators in facilitated has facilitated learning
strategies elicit learning. regularly /daily
interaction from a class

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 b. Participated learning *If the teacher has not met 4- Very Satisfactory- The
project-based/ the five characteristics, the teacher has facilitated
cooperative rater would deduct points. learning frequently
learning strategies
3- Satisfactory. The teacher
c. information and
Communication has facilitated learning
Technology( ICT ) twice a week.
integration (i.e. 2- Unsatisfactory- The
Multimedia, etc) teacher has facilitated
d. Localized Instructional learning once a week
Materials/ Models(e.g. 1-Poor. The teacher has
module, 3 D models
facilitated learning once in
etc.)
e. Strategic Intervention two weeks
Materials (SIM)
f. Compilation of
Independent
Cooperative Learning
(ICL) Materials/
Compilation of
Worksheets/
Compilation of Activity
Sheets
Weight PERFORMANCE INDICATORS ACTUAL RATING SCORE
MFOs KRAs OBJECTIVES TIMELINE per KRA QUALITY Efficiency Timelines RESULTS
s
5-Outstanding.Passed
2. Learners 1. Monitored, evaluated, 15% The teacher has evidence 2 days before the
Outcomes maintained pupils/ accomplished all the deadline
(30 %) students progress and indicators stated under the 4- Very satisfactory. Passed
analyze learners objective. evidence 1 day before the
performance deadline
Required evidence: *If the teacher has not met 3-Satisfactory. Passed
a. Class the five characteristics, the evidence on the deadline
Record/eClass rater would deduct points 2- Unsatisfactory. Passed
Record evidence 1-3 days after the
b. Summary of deadline
Grades

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 c. Grading Sheet 1-Poor. Passed evidence 4-
d. Learners Portfolio/ 5 days after the deadline
Assessment Tools
(e.g Quiz
Notebook,
Summative Test,
Rubrics)
e. Table of Specifications
(TOS) of Test Questions
(TQ) for Senior High School
Teachers
f. Analysis Report ( Item
Analysis, Frequency of Correct
Response/ Errors
Academic Ranking
g . Summative Test Bank
2.Monitored attendance, 5-Outstanding.
diversity appreciation, safe , 10% The teacher has Accomplished the
positive and motivating accomplished all the indicators monthly
environment, overall and indicators stated under the 4- Very Satisfactory.
physical atmosphere, objective. Accomplished the
cleanliness and orderliness of indicators every 3 months
classrooms including proper *If the teacher has not met 3- Satisfactory.
waste disposal the five characteristics, the Accomplished the
Required evidence: rater would deduct points indicators every six months
The teacher must provide a 2- Unsatisfactory.
valid documentation of the ff. Accomplished indicators
a. Inclusive/ multi- only once within the
cultural/accepting present school year
environment by having 1-Poor. Not accomplished
zero case of bullying. anything
b. Stress-free classroom
setting
c. Well-structured well
kept, orderly, well lit
and well ventilated
classroom
d. Presence of bins of
waste segregation/
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 presence of divan
containing cleaning
materials
e. Updated attendance
chart ( SF2)
f. SF1 ( Students Profile)
g. Safety Evacuation Plan
/First Aid Kit
h. Presence of indoorand
outdoor plants
i. Presence of Personality
Corner
j. Presence of bulletin
board/ Reading Corner

Note: all relieving teachers

should adopt one classroom
except star section or any
academic track in Senior High
School (SHS), adviser will rate
their performance
3. Attained the required
General Scholastic
Aptitude (GSA) for
grade level (Failure
Rate) or Achieve no
Drop Out (per advisory
class)
a. Form 138
b. Form 137
c. SF5
Note: all relieving teachers
should present class record and
summary of grades in all
subject areas.
5% 5- Outstanding- No
failures/no drop-out
4- Very Satisfactory. One (1)
Failure/drop-out
3- Satisfactory. Two (2)
failures/drop-out
2- Unsatisfactory- Three (3)
failures/ drop-out
1-Poor. Four (4) or more
failures/ drop-out
5- Outstanding. Accomplish
at least one evidence on or
before the deadline.
4-Very Satisfactory.
Accomplished all evidence
1-2 days after the deadline
3- Satisfactory-
accomplished all evidence
3-4 days the deadline
2- Unsatisfactory.
Accomplished all evidence
5-6 days after the deadline
1-Poor . Accomplished all
evidence one week after
the deadline

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MFOs KRAs OBJECTIVES TIMELINE Weight PERFORMANCE INDICATOR ACTUAL
per KRA Quality Efficiency RESULTS
3. 1. Undertaken/ initiated
Community projects/ 5-Outstanding. Has been 5- Outstanding. Has been
Involvement events/activities/ 15 % involved at least five (5)or involved at least five
(20%) Sponsorship more events / activities events/ activities with in
Required Evidences: 4- Very Satisfactory. Has the school year
Certificate of Recognition/ been involved at least four 4- Very satisfactory. Has
Appreciation/ Participation on (4) events/ activities been involved at least four
the following activities: events with in the school
a. Emceeing/ hosting 3- Satisfactory- Has been year
b. Tree planting involved at least three (3) 3- Satisfactory. Has been
c. Medical/dental mission events/ activities involved at least three
d. Coastal clean up 2- Unsatisfactory. Has been events with in the school
e. Feeding program involved at least two (2) year
f. Fun run events/ activities 2- Unsatisfactory. Has been
g. Eco-walk 1 Poor. Has been involved involved at least two
h. Humanity walk in one (1) event with in the events with in the school
i. Wellness program school year. year
j. Gift giving 1 Poor. Has been involved
k. Committee chair and in one event with in the
membership school year
l. Event organizer
m. Guest speaker
n. Judge
o. Officers in duly
recognized community
organization
p. Disaster coordinating
council
q. Resource generation
worth at least 1000.00
r. Benefactor (adopt-a-
student program)
s. Attended any school
and civic events(e.g
intrams, Science Fair,

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 town fiesta, alumni
home coming)
t. Representative to
comunity events
The teacher has 5- Outstanding.
2. Conducted accomplished all the Accomplished the
5%
regular/periodic PTA indicators stated under the indicators every grading
meetings/ conferences objective. period or as needed
and visited parents of 4- Very Satisfactory
students needing *If the teacher has not met Accomplished the
academic monitoring/ the five characteristics, the indicators thrice within the
follow up rater would deduct points present school year
3- Satisfactory .
Required evidences: Accomplished the
a. Notice/ letter to indicators twice within the
parents/ guardians present school year
b. Agenda/ Schedule 2- Unsatisfactory.
c. Minutes of the meeting Accomplished indicators
d. Attendance Record only once within the
duly signed by present school year
attendees 1- Poor . Not accomplished
e. Documentation anything
(pictures)
f. Principals Permission
for Home Visitation
Form/ feedback/
Progress Report with
documentation ( for
students at-risk only)
g. Attendance record

Note: all relieving teachers

should adopt the same
classroom/ home room except
star section or any SHS
academic tracks

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 PERFORMANCE INDICATOR ACTUAL
MFOs KRAs OBJECTIVES TIMELINE Weight RESULTS RATING SCORE
Quality/ Efficiency/ Timeliness
per KRA
1.Received Special Awards/
4 . Citation/ Recognition for 5% 5- Outstanding. The teacher has received 2 special
Professional exemplary performance awards or has or has done at least five (5) of the special
Growth and (i.e.. Outstanding Teacher in tasks successfully within the present school year
Development school, district, municipal, 4- Very Satisfactory. The teacher has received one special
(20%) division, region, national, award or has at least four (4) of the special tasks
international level) successfully within the present school year
2. Have done special tasks 3- Satisfactory. The teacher has done at least three (3)
assigned by school admin and special tasks successfully
DepEd officials 2- Unsatisfactory. The teacher has done at least two (2)
a. Enrolment Officer special task successfully within the present school year
b. School Paper / Club 1 Poor- The teacher has one (1) special task within the
Adviser/ Research Adviser present school year
c. Scout Master
e. Substitute Teacher
f. Technical/ Computer
Assistant
( department)
g. Computer Technical
Coordinator
h . Department Treasurer,
Auditor, Secretary, Encoder
i. Members of the Council of
Assesors
j . Learning Competency
Planner
k . Data Keeper
l. Judge on Cleanliness and
Beautification of the School
m. Prefect of Discipline
n . Play Director/ Member of
Production Team/ Scriptwriter
o . Visual/ Graphical/ Layout
Artist

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p. Open- High school
Monitoring Teacher
q. Special Program
Coordinator
r. Property Custodian / Supply
Officer
s. Remedial Teacher
t. Speech Writer
u. Student Teacher Mentor
v. Authorized Agency Officer
w. Field Trip Coordinator/
Outside of the School Event
Assistant
(e.g. Play Viewing)
x. BEI Election Officer/
Inspector
y. NAT/ NCAE Proctor/
Examiner
Required Evidences:
a.Certificate of Designation/
Recognition/ Appreciation/
Participation/ Appearance
a. Documentation
(Pictures)
2 The teacher should be one 5- Outstanding. The teacher has attained one of the
of the following: 5% following within the present school year:
a. Coached a player a. Winning coach (International, National, Regional)
contestant b. Successfully officiated three (3) games
b. Game Officiator c. Mentored three (3) co- teachers
c. Co- teachers mentor d. Organized/ facilitated at least two seminars
d. Seminar Organizer/ e. Demonstrated teaching strategies, methods at
Facilitator least three (3) times
e. Resource speaker of f. Created new teaching strategies
any school events and g. Created or designated effective instructional
programs materials
f. Demonstrating 4- Very Satisfactory
teacher a. Winning coach (division/ District)
g. Innovator b. Successfully officiated two (2) games
c. Mentored two(2) co-teachers
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 (i.e. school. District,
division, region,
national, international
level)
Required Evidence
a. Certificate of
Appearance/
Participation/
Recognition/
Appreciation
b. Documentation
h. Attended trainings,
seminars, workshop 5%
or conferences
(school, division,
region, national,
international level)
Required Evidence(s):
a. Certificate of
Appearance/
Participation/
Recognition
b. Official Receipt
c. Memorandum/
Advisory/ Invitational
d. Travel Order/
Authority to Travel
e. Pictures( Official
Documentation Only)
f. Narrative Report
g. Accomplishment
Report
h. Echo Seminar
d. Organized/ facilitated at least one seminar
e. Demonstrated teaching strategies/ methods at
least twice
3- Satisfactory
a. Coach, assistant coach
b. Successfully officiated one(1) game
c. Mentored one (1) co-teacher
d. Demonstrated teaching strategies at least once
(1) and or introduced an innovation within the
present school year
2- Unsatisfactory- Has unsuccessfully organized /
facilitated a seminar officiated game, demonstrated
teaching strategies within the present school year
1 Poor. Has not organized/ facilitated a seminar, has not
officiated a game, has not coach, has not demonstrated
teaching strategies within the present school year
5- Outstanding. The teacher has accomplished at least
four (4) evidence within the present school year
4- Very Satisfactory. The teacher has accomplished at
least three (3) evidences within the present school year
3- Satisfactory. The teacher has accomplished at least
two (2) evidences within the present school year
2- Unsatisfactory. The teacher has not accomplished any
one (1) of the evidence within the present school year
1 - Poor. The teacher has not accomplished any of the
evidence within the present school year
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i. Attended post- 3%
graduate studies
5 The teacher must attain
one of the following:
Conducted and participated in 2%
research ( individual,
department, school, district,
division)
a. Produced Publications
- Correspondent
- Contributor
- Proofreader
b. Authored/ Co-
Authored
Compiled Innovative
teaching materials
(e.g. books, modules,
Strategic Intervention
Materials,
worksheets,
independent and
cooperative learning
material, ICT/
multimedia
compilations,
reviewers, etc.)
Required Evidence:
Certificate, Documentation,
Outputs
5- Outstanding. MA Graduate/ Obtained Ph.D./Ed.D
units/Ph.D./Ed.D Graduate at present
4- Very Satisfactory. Completed Academic Requirements
in MA at present
3- Satisfactory. Obtained MA 18-24 units at present
2- Unsatisfactory. Obtained MA 10-17 units at present
1. Poor. Obtained MA 9 units and below at present
5- Outstanding. Conducted/ participated one duly
approved and implemented research in the classroom/
adopted research in the whole school ,division, cluster,
district. The teacher has submitted research article on or
before the deadline.
4- Very Satisfactory- Conducted/ participated one duly
approved and implemented research in the classroom/
adopted research in the whole school, division, cluster,
district. The teacher has submitted research article one
day after the deadline
3- Satisfactory. - Conducted/ participated one duly
approved and implemented research in the classroom/
adopted research in the whole school, division, cluster,
district. The teacher has submitted research article two
days after the deadline
2- Unsatisfactory. Conducted/ participated one duly
approved and implemented research in the classroom/
adopted research in the whole school, division, cluster,
district. The teacher has submitted research article three
days after the deadline.
1 Poor. Had no research / article
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 Weighted
*To get the score, the rating is multiplied by the weight assigned Average Mean
*Plus factor is incorporated in the professional development area

OVERALL
RATING

Individual Performance Commitment and Review Form

LETICIA S. SALDO_ MARCIANA F. DONGUIZ Dr. ROWENA C. BANZON ,CESO V

Rater Ratee Approving Authority

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