MENGO HOSPITAL- STAFF PERFORMANCE APPRAISAL FORM

Employee Name: NANYONGA BRENDA SSEKISONGE

Employee Number: Supervisor's Name
Job Title: ENROLLED NURSE Justine Nalwadda
Department: EYE, NURSING Supervisor's Job Title:
Unit/Section: EYE WARD Manager Eye
Date Joined: Sunday, July 1, 2018 Head of Department's Name:
Today's Date Tuesday, April 4, 2023 PNO, SR, Prossy Kibuuka
Date of Review:
Duration in MH (Yrs) 4Years,9Months,3Days
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 1: To ensure that

patients/clients understand the
Availability of receipts
Financial Objectives

different payment categories, and 20.0% 100% 90% promise to improve 0%

clinic master records
make the payments before they
receive services
35%

Upto date inventory

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. 0%
books, discharge, handover
during my shift
books, inventory books,
15.0% requisition book
0%

To ensure all patients are done Visual

Documentation in clinic
Acuity and other vital signs (BP, RBS, I will improve by
5.0% master, medical form 5, 100% 95% 0%
Temp) according to the required learning more skills
reports
ophthalmic nursing standards
Processes/ Operational Objectives

15% Proper waste in each

Target 2: To assist ophthalmic Clinical
segregation bin, using PPEs
Officers (OCO) and Ophthalmologists
5.0% (Masks, gloves, goggles), 100% 95% I will improve 0%
during examination each patient in the
use of available checklist,
examination/consultation rooms
Sops

Professional appearance and code of Professional Uniform while

100% 95% am always smart 0%
dressing while on duty on duty

5.0%
0%

Target 1: To ensure that I offer

Complaints Received and
effective and efficient service in a to continue doing a
10.0% Registered in the customer 100% 90% 0%
conducive environment which is safe, great job
Customer Objectives

satisfaction survey
clean, with less distraction/ noise etc

20%
 Customer Objectives
20%

am doing a good jobI

do come early but
Target 2: To ensure that patient Complaints Received and
there are so many
waiting time is reduced depending on Registered in the customer 100% 90% 0%
processes that need to
the condition satisfaction survey
be accomplished while
the patient is withus.
10.0%
0%

I have good
People Objectives

Customer Care and good Service Complaints Received and

5.0% 100% 90% relationship with staff 0%
attitude to clients and to staff members Registered
members and patients
10%
Reports, Duty Rotas, and
Dependability: Commitment, good
Attendance
attendance, punctuality, and with 100% 90% I promise to improve 0%
records,Clocking System
minimal or no cover requests
5.0% etc
0%
Competency
Behavioral
Values &

20% MENGO HOSPITAL (VALUES & BEHAVIOURAL COMPETENCIES) 0%

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 2 I promise to 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
3 am doing a good job
styles to different situations and different colleagues, and to motivate teams into fellow workers
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 am very responsible 3 am doing a good job
dealings, respects surbodinates, colleagues, suppliers, customers and company
property.

4) Professionalism: Able to set own realistic deadlines and can be relied on to I act profesional 3 am doing a good job
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 am doing a good job
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 am doing a good job
that further the need to satisify customers' expectations.
consideration

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

I will learn more 3 am doing a good job

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 care a lot 3 am doing a good job
in entrenching virtues of kindness, Jesus' love, suffer with the patience and a
willingness to help others no matter the cost.
29
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 Computor skills couching, mentorship, guiding, attending CPDs
2 Leadership skills couching, mentorship, guiding, attending CPDs
3

APPRAISEE’S COMMENTS
I have liked the appraisal session and promise to improve where necessary.

NAME : NANYONGA BRENDA SSEKISONGE Signature NC DATE :

SUPERVISOR'S COMMENTS

NAME : Justine Nalwadda Signature DATE :

HEAD OF DEPARTMENT'S COMMENTS

NAME : PNO, SR, Prossy Kibuuka Signature DATE :