<p> Associate Evaluation Form</p><p>NAME: ______DATE: ______</p><p>Evaluation work sheet completed by ______Doctor/Manager ______</p><p>Purpose: To allow an objective evaluation of a Associate’s job performance To be a record-keeping device necessary to maintain an accurate record of the associate’s career development.</p><p>Guidelines: A performance review is done on or around an associate’s employment anniversary date. It should be accomplished two times per year The associate and doctor/manager prepare an evaluation individually prior to the joint discussion as to what improvements will be asked to be made following evaluation. Enough time should be allotted for the discussion/review. Best results are attained if it is not held at the end of a workday. This evaluation form is not to b used as a tool for criticism or vengeance, instead as a vehicle, which allows the associate to identify strengths and limitations. Once the limitations are identified, the associate can implement a self-improvement program.</p><p>Scoring: 1-3 limited, 4- 5 strengths Fails to meet minimum requirements Rating of 1 Meets minimum requirements Rating of 2 Meets requirements Rating of 3 Exceeds requirements Rating of 4 Rarely equaled Rating of 5 PERSONAL FACTORS</p><p>ABILITY TO DEAL WITH PATIENTS TIME EFFECTIVENSS – “Make productive use of Time” _____Remains calm under stressful situation _____Organizes work time and space _____Conversations with patients are about the _____Organizes and maintains instrument trays patient, not about the associate _____Organizes and maintains treatment rooms _____Courteous with patients, other doctor(s) and _____Inventory control of supplies team member(s).</p><p>_____Tactful, diplomatic, respectful PUNCTUALITY – “Ability to be prompt”</p><p>_____On time for huddles and other meetings TEAM ORIENTED – “Has work together attitude _____On time with assigned tasks (reports, projects) _____Cooperates with assistants & hygienists _____On time after lunch break _____Supports the practice vision & goals _____Assists the assistants in “managing his/her time to _____Encourages others to perform well stay on schedule”</p><p>ADAPTABLITY – “Accepts change without SPEECH – “Exhibits control of English language” aggravation” _____Vocabulary/grammar – effective work choice usage _____Flexibility in daily routine of schedule _____Thought clarity – speaks without confusing self and _____Deals well under stress of daily schedule others</p><p>_____Attitude remains positive under stress _____Normal Voice tone</p><p>_____Refrains from usage of distasteful language NEATNESS/APPEARANCE</p><p>_____Maintains a non-clutter work area ATTITUDE </p><p>_____Legible record keeping _____Avoids moodiness</p><p>_____Maintains well groomed status throughout the _____Presents cheerful image daily workday (dress-uniform, hair, nails, oral hygiene,etc) _____Keeps personal problems out of office</p><p>PROFESSIONALISM ACCURACY – “Is detailed oriented” _____Job – Position knowledge _____Is exact and precise _____Maintains confidentiality of patients and practice information _____Avoids repetitive errors CREATIVITY _____Maintains clinical skills thru CE courses _____Comes up with new ideas _____Communication skills with patient, doctor, team _____Formulates workability of ideas, follow thru _____Handling recare system daily check to make sure pt has been in for recent recare _____Unafraid to voice _____Maintains X-ray skills _____Shows initiative at team meetings _____Capable of patient prevention instruction</p><p>ABILITY TO TAKE DIRECTIONS _____Maintains positive attitude with patient </p><p>_____Does not require repetitive prompting _____Presents treatment recommendations to patients</p><p>_____Listens as well as hears without interruptions _____Keeps personal problems out of office</p><p>_____Follows instructions without hesitation _____Is exact and precise</p><p>_____Maintains firm financial arrangements with STRIVES FOR SELF IMPROVEMENT patients each and every treatment plan _____Seeks out CE and pursues advance certification _____Maintains with patients to avoid the insurance _____Sets personal and practice goals for self traps of only doing what insurance will pay, etc.</p><p>_____Accepts constructive criticism with positive _____Preventive health oriented attitude from the doctor of the practice. _____Believes and practices preventive oral hygiene</p><p>_____Minimal utilization of “watching” instead of doing SCHEDULING : procedures.</p><p>_____Efficient scheduling (perfect day to goal)</p><p>_____Organizes and maintains patient recall</p><p>_____Organizes and maintains New Patient Calls prior to initial appointment</p><p>_____Organizes and maintains Phone skills (awesome customer service conversation during post operative calls</p><p>_____Greeting patients with respect, handling ER patients no differently than regular patients Practice Standard of Care Philosophy:</p><p>_____Patient motivator and educator to accept treatment</p><p>_____Follows treatment recommendations according to the Practice Standard of Care Guidelines</p><p>_____Accepts and Supports practice philosophy of dentistry</p>