Performance Evaluation Form
Office:
Please Select
Bell
Phoenix - 35th
Phoenix - PCH
Name:
First Name
Last Name
1. Overall how would you rate this individual's performance based on your expectations for the role?
Rows
Significantly Below Expectations
Below Expectations
Meets Expectations
Above Expectations
Significantly Above Expectations
SING, SONG, DANCE
Personal
appearance:
Courage to confront problems directly, taking action and being decisive.
Demonstrates Responsibility for good attendance and punctuality:
Communicates changes with patients, doctors and teammates
Completes work on time: prophy time, break down, tray setup, chart notes:
Performs well with out supervision:
Performs well under pressure:
Responds positively to critical review, changes and training:
Maintains/handles equipment, maintains clean working areas, lab, bays, and treatment rooms
Conducts self in professional manner
2. Please indicate the competency in which this teammate most excels at, and provide explanation as to why (specific examples are desired).
4. What has this teammate accomplished this year that has had the biggest impact on you?
5. In what way(s) does this teammate contribute to overall team objectives and goals?
6. What specific areas or skills do you believe the teammate should focus on for improvement?
7. What action plans or steps can be taken to help the teammate address these areas of improvement?
8. Are there any recommended training or development programs?
Teammate Signature:
Manager Signature:
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