Dental Assistant Peer Evaluation Form

Performance Evaluation
Dental Assistant Department
Team member:
A performance review is an opportunity for self-growth and self-introspection. It also gives your supervisors the opportunity to provide constructive feedback. The goal is to help define areas of performance you excel and define areas that may need improvement. Utilizing the feedback received, will help you focus on implementing ideas to enhance your performance.
How to Complete Review:
You will rate areas of performance by clicking the stars.
The highest/best rating is 5 stars, the lowest/worst rating is 1 star.
If you choose 3 stars or less, please leave a comment or examples to reflect on why.
Thank you
Dental Assistant Leadership Team

1. Reliabilty - Are you here for the team? Do you call-in often?
Less than 3 stars please leave a comment or example to explain why

2. Punctual - Do you arrive to work on time to prepared for the day
Type a question

3. Appearance - Do you come to work looking professional? Do you follow uniform guidelines ?
Less than 3 stars please leave a comment or example to explain why

4. Team player - Do you take initiative to help others on your care team and full team?
Less than 3 stars please leave a comment or example to explain why

5. Approachable - Are you easy to talk to and can take constructive criticism well?
Less than 3 stars please leave a comment or example to explain why

6. Productivity - Do you stays busy, find tasks to do when not with a patient?
Type a question

7. Self Accountability - Do you take ownership for your mistakes, makes correction and apply it going forward?
Less than 3 stars please leave a comment or example to explain why

8. Attitude - Do you have a positive attitude? Do you stay away from negativity and gossip?
Less than 3 stars please leave a comment or example to explain why

9. Operatory Appearance - Do you keep your operatory room clean presentable for patients, organized, neat and in order?
Less than 3 stars please leave a comment or example to explain why

10. Scripting - Do you follow scripting guidelines when speaking to patients, give a good explanation of treatment and post op instructions?
Type a question

11. OSHA and CDC guidelines - Follows protocols, disinfects properly and practices good safety measures?
Less than 3 stars please leave a comment or example to explain why

12. Flexibility - Are you flexible with working on another team at a different location or with another doctor? Do you volunteer when the team is short handed?
Less than 3 stars please leave a comment or example to explain why

Additional feedback is always helpful. This is the opportunity to reflect on something you may be struggling with or need additional training.

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