MENGO HOSPITAL- STAFF PERFORMANCE APPRAISAL FORM

Employee Name: Nanyonga Brenda Ssekisonge

Employee Number: Supervisor's Name
Job Title: Enolled Nurse
Department: Eye Department Supervisor's Job Title:
Unit/Section: Eye private
Date Joined: july, 2018 Head of Department's Name:
Today's Date Tuesday, April 4, 2023
Date of Review:
Duration in MH (Yrs) #VALUE!
Reason for Appraisal Mid-year review Version 001.2020. Mulangira Geofrey

SECTION 1. EXPECTED KEY RESULT AREA (ROLE- KRA or DELIVERABLES)

Employee performance will be measured against set objectives & overall role deliverables. Supervisors will comment with relevant examples, on the Appraisee's Performance on the Hits and Misses for the Period.

EVIDENCE SOURCE/MEANS EMPLOYEE SUPERVISOR'S

BSC PERSPECTIVES TOTAL WEIGHT KEY PERFORMANCE AREAS UNIT WEIGHT TARGET SELF ASSESSMENT SUPERVISOR'S COMMENTS SCORE
OF VERIFICATION COMMENTS ASSESSMENT
Target 1To ensure that patients/clients
understand the different payment Availability of receipts
Objectives

20.0% 100% 90% Am doing well

Financial

categories, and make the payments clinic

Upto date
master
inventory
records
35% before they receive services Patients record books,
Target 2:To ensure that I take good
ward reports, admission
custody of all department equipment 100% To
95%
continue with documentations and monitoring.
books, discharge, handover
during
Target my shift
1: To give quality nursing care 15.0%
books, inventory books,
to all patients as I carryout, visual requisition book
acuity, vitals, assisting Documentation in clinic
Processes/ Operational

clinicians/doctors, Pan retinal 5.0% master, medical form 5, 100% 95% I have been doing this very well
photocoagulation
Target PRP, YAG
2: To Participate Laser
in all quality Proper reports
waste in each
Objectives

capsulotomy,
improvement RBS and opthalmic
projects including; drug segregation bin, using PPEs
administration
proper etc.
waste management, 5 s, having 5.0% (Masks, gloves, goggles), 100% I have 95%
been attending meetings but hope to participate more
15%
protective personal gears, SOPs, check use of available checklist,
lists, etc Sops
Professional appearance and code of Professional Uniform while
100% 95% am always smart
dressing while on duty on duty
5.0%

Target 1; To ensure that I offer

Complaints Received and
effective and efficient service in a
Objectives

10.0% Registered in the customer 100% 90% I promise to improve

Customer

conducive environment which is safe,

Target 2:To less
ensure that patient waiting satisfaction survey
20% clean, with distraction/ noise etc
time is reduced depending on the Complaints Received and
condition, the processes required such Registered in the customer I do come
100%
early but there are90%
so many processes that need to be accomplished while the patient is withus.
as VA, Examination, refraction, OCT, 10.0% satisfaction survey
YAG etc
People Objectives

Customer Care and good Service Complaints Received and

5.0% 100% 90% I promise to improve
attitude to clients and to staff members Registered

10% Reports, Duty Rotas, and

Dependability: Commitment, good
Attendance
attendance, punctuality, and with 100% 90% I promise to improve
records,Clocking System
minimal or no cover requests
5.0% etc
0%
Competency
Behavioral
Values &

20% MENGO HOSPITAL (VALUES & BEHAVIOURAL COMPETENCIES)

0%
OVERALL RATING 0%
POOR PERFORMANCE

Outstanding
Fair Performance ("D" Good Performance Very Good Performance ("B"
Poor Performance ("E" Rating) Performance ("A"
Rating) ("C" Rating) Rating)
Rating)

Below 50% 51%-60% 61%-80% 81%-90% 91%-100%

Please note the Overall Assessment is derived from the "Performance Descriptors" below in relation to the Appraisee Performance Achievement
 SECTION 2. VALUES & BEHAVIORAL COMPETENCIES ( Rate Behavior on a 1- 3 Scale using the Performance Descriptor)
Employee Self
Performance Descriptors: Assessment. Employee's Supervisor
MENGO HOSPITAL VALUES Supervisor Comment
Drop Down Measured on a scale Comment Assessment
of 1-3

1) Christ Centred : Having a faith/religious attitude. Puts God ahead of all activities I do attend prayers 3 I will improve
and conducts themselves in manner considered morally right.i.e.leading prayers,
singing, devotion, praising, sowing for christ, exemplary morals.

2) Team Work: Potraying apositive attitude. Able to work with and apply suitable I have good relationsip with I will continue doing
3
styles to different situations and different colleagues, and to motivate teams into fellow workers it
MENGO HOSPITAL VALUES/BEHAVIOUR COMPETENCIES

achieving results with dignity & respect.

3) Integrity: Is responsible and has a sense of accountability. Honest & fairness in all I will continue doing
I am very responsible 3
dealings, respects surbodinates, colleagues, suppliers, customers and company it
property.

4) Professionalism: Able to set own realistic deadlines and can be relied on to I act profesional 3 I will improve
deliver. Conducts themselves well in ethical and polite behaviours. Always acts in the
best interest of the customers & hospital

5) Accountability: Takes full responsibility for all work, assigned activities, accepts I do proper accountability 3 I wll improve
responsibility and discloses the results in a transparent manner.
I always suggest my opnions
6) Innovation: Has inspiration. Seeks new ways & suggests practical ideas/solutions
but are not put under 3 I will improve
that further the need to satisify customers' expectations.
consideration

7) Excellence: seeks new ways & suggests practical solutions. Strives for high I always improvise where I will continue doing
performance & adheres to Hospital set standards. Uses minimal resources to deliver 3
necessary it
value for money & process improvements.
8) Safety Consciousness : Showing regard to the working environment and taking I will continue doing
I do it 3
steps to avoid accidents, safety for lives and property it

I will learn more 3 I will improve

9) Leadership: Motivate & inspire surbodinates/team to perform at their optimum.
Identifies gaps and develops appropriate solutions to the challenges.

10) Caring: Conforming to the ethical practices of duty to care, and exceeding effort I will continue doing
in entrenching virtues of kindness, Jesus' love, suffer with the patience and a I care a lot 3
it
willingness to help others no matter the cost. She does care for both internal and external customers
30 0
Total Points - Values & Behavioral Competencies

SECTION 3: INDIVIDUAL DEVELOPMENT PLAN

Record 3 development goals for the next year in Section 3 below: These are individual learning needs to support job Performance and or Career development
Number Development Need Development Action
1 Leadership and management skills Couching, mentoring, monitring, supervision, and training
2 computer skills Addition in compuetr skills
3

APPRAISEE’S COMMENTS

NAME : NANYONGA BRENDA SSEKISONGE Signature DATE :

SUPERVISOR'S COMMENTS
Brenda has been identified as one of the most hard working young nurse. Her performance is indeed promising. Keep it up

NAME : Signature DATE :

HEAD OF DEPARTMENT'S COMMENTS

NAME : 0 Signature DATE :