Blank Performance Assessment - Assistant updated 6-15-23.xlsx

	A	B	C	D	E	H	I	J	K
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2	Team Member Performance Assessment
3	Dental Assistant
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5	Team Member Name:						Date of Hire:
6	Date of review:
7	Date of last review:	N/A
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9	Performance Rating	Explanation							Points Earned
10	Exceeds Expectations	This rating indicates that you consistently exceed in your job performance. You go above & beyond the basic expectations in a given area.							3
11	Meets Expectations	This rating indicates that you perform your job task at the basic level that is expected of you. You understand your job requirements & you meet all aspects of it with minimal supervision.							2
12	Additional Development Needed	This rating indicates that you are not completely performing your job tasks at an acceptable level. This may be due to your actual time in the position, whereby more training is indicated, or it may be due to a greater commitment level needed on your part to develop within a particular job area.							1
13	Below Expectations	This rating indicates that you require ongoing supervision in the performance of your duties. You fail to meet the basic job expectations, despite having been provided adequate training & feedback.							0
14	Weight Factor	Not all things are created equal. While it is important to master all aspects of your job position, there are certain aspects of your position on the team which are more critical to mastering & implementing than others. Each job characteristic &/or task has been given a weight factor, from 1-3, reflecting its importance in the overall evaluation of your contributions to the team. Your points earned in each category will be multiplied by each weight factor to help determine your overall Performance Rating.							1-3
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17		Below Expectations	Additional Development Needed	Meets Expectations	Exceeds Expectations	Comments
18	PERSONAL CHARACTERISTIC / JOB TASK	0	1	2	3
19	Dependability & Flexibility - The team can depend on you to be where you need to be; your personal days are well planned for; you seek to provide coverage for your position so as not to burden the rest of your team; you arrive to work on time & take allotted & necessary breaks; you recognize when you are needed the most & you make accommodations; you are able to accommodate & accept office & patient scheduling changes with ease. You only take allotted time off per handbook.
20	Professional Appearance - You are professional in your dress at all times; your hair is clean & always put back; your nails are neatly manicured & professional in length; your make-up is applied with good taste & appropriate; your jewelry is not excessive & is consistent with the guidelines provided in the team member handbook.
21	Productivity & Quality of Work – You accomplish your work assignments in a timely manner; you complete your job tasks with accuracy & dependability; you pay attention to detail & have a strong sense of quality & how to achieve it in everything that you do; you are committed to & take pride in providing an excellent final product; you seek out ways to improve what you do as well as expanding your own capabilities when time permits.
22	Organization & Neatness – Your work area is organized & neat at all times; your space is free of clutter; you are considerate of & respect your team member’s space as well as community office space; your communication box is emptied daily.
23	Ownership & Commitment – You take ownership in your position; you are accountable first to yourself & then to the rest of your team; you take responsibility for what is yours & you are not defensive when short comings are pointed out to yoiu; you take responsibility for your mistakes; you seek ways to improve & excel in your area; you demonstrate a desire for team success; you are willing to sacrifice personal desires for overall needs; you make a positive, recognizable contribution to the office.
24	Promoter of Teamwork – You are a source of encouragement & appreciation to your team members; you are willing to pitch in no matter what the task to get the job done; you display good listening skills; you show sensitivity & empathy to the needs of others; you display integrity in your commitments; the team can depend on you to follow through with what you say you will do; you do not participate in gossip at any level; you speak honesty & truth at all times; you display confidentiality at all times.
25	Proactive & Resourceful – You are proactive in doing what most needs to be done without being asked; you feel empowered when necessary & you can make decisions that are best for the patients & for the office overall; you use good judgment at all times; you can discern what is important & what is not; you appropriately gather all facts before making a decision; you are resourceful & able to identify & resolve problems that are presented to you with realistic solutions; you know how much you can handle & you ask for help when necessary; you offer solutions when presenting problems that need solving.
26	Independent - You are able to work independently; you are self-motivated & do not need someone to tell you what needs to be done; you can evaluate a situation & jump in without being asked; you can re-establish priorities using your own judgment & an understanding of what is best for the patients & the group as a whole; your time does not need to be "managed".
27	Personal Demeanor & Attitude - You have a positive attitude when at work; you smile often; you look to the positive side of things & you encourage others to do the same; you leave personal issues out of the office; when you are not 100%, you own your situation & you communicate your needs to your team members; you do not participate in negative talk that goes on between other team members; you take opportunities to turn negative situations into positive ones; you embrace change & recognize that it is a means to growth & improvement.
28	Team Meetings – You participate enthusiastically in both morning huddle & team meetings; you provide open & honest communication; you communicate your thoughts clearly & professionally & always with respect to others in the group; you arrive on time & you are prepared to participate.
29	Patient Relations - Patients are greeted with enthusiasm & warmth; personal touch is used appropriately; you offer patient amenities consistently to all patients; you always take the time to make patients feel special regardless of the schedule; patients never feel rushed in your care; patient handoff is always done correctly.
30	Patient Education - You spend time in the treatment room(s) educating patients on general & cosmetic dental procedures; you talk to the patient in the absence of the Dr. about available treatment options; you spend time discerning what a patient's chief complaint is as well as their long term dental health goals; you communicate your information to the Dr.; you inform the patient of all the various procedures the practice offers to our patients; you note in the progress notes discussions you have with the patient; you always communicate pre- & postoperative instructions to patients with confidence & credibility.
31	Referrals & Reviews - You ask patients to refer their family & friends; you ask patients to give us an online review; you respond to any inquiries or negative reviews.
32	Follow Through - you perform procedures efficiently & try to maximize patient comfort; you take proper impressions; you pour up models & fabricate trays quickly & accurately; you deliver post treatment instructions with accuracy & clarity; you follow through with patient treatment from beginning to end; you have patients sign all necessary consent forms prior to beginning treatment.
33	4- Handed Dental Assisting – Your treatment rooms & procedure trays are alwatys prepared; once you start a procedure you rarely need to get up to get materials or instruments; you anticipate the Dr.'s needs at all times & for all procedures; you can quickly modify a procedure being done based on a changing treatment plan; you are aware of the patient's emotional & physical needs throughout procedures; you maintain good non-verbal communication with the Dr. throughout procedures.
34	Overall Understanding of All Dental Procedures - You have a good understanding of all dental procedures; you can explain the process of all procedures to patients with confidence & credibility; you can answer patient questions regarding pre- & post operative expectations based on your knowledge of the procedures.
35	Radiographs & Intraoral Camera – You take radiographs & photos that are of diagnostice quality; you are proactive in taking necessary films & photos based on patient's chief complaints & without waiting for the Dr. to direct you; you utilize the x-ray equipment & the intraoral camera equipment properly & with care; you understands what procedures require x-rays for insurance reimbursement & you always takes necessary films for this purpose; you understand the benefits of taking photos to educate & motivate patients to accept their treatment plans & you use the camera frequently; you have the camera ready for the Dr. to use frequently & quickly.
36	Patient Charting & Record Keeping - You utilize all patient forms appropriately & make sure they are uploaded to the patient's Doc Center; you are thorough in your documentation; you follow & use all appropriate abbreviations when writing notes; you check for spelling errors; your charting is completed before leaving for the day; you utilize all aspects of the computer correctly relative to patient charting; you always have patients sign proper consent forms prior to starting any treatment; treatment plans are entered & prioritized properly.
37	Offering additional products to Patients - You recognize patients who are good candidates for whitening, fluoride, & products. You discuss the procedures & products frequently with patients
38	Fabrication of Temporary Crowns - You fabricate temporary crowns proficiently; the termporsary crown fits well with proper color matching, contact & margins; the patient is comfortable throughout the procedure.
39	Impressions & Study Models - You are able to take exacting impressions with minimal re-dos; you are able to take impressions with the proper materials & without wasting materials; you are able to pour up study models from alginate impressions with both stone & plaster; you can artistically trim models so they are presentable to both patients & labs; you follow through with this task from beginning to end, including cleaning up lab areas so as not to leave a mess for other team members.
40	Lab Cases - You utilize the computer for printing prescriptions for all lab cases; you write prescriptions completely & accurately with all necessary information included; you follow up on all cases so that they are returned timely; when cases are returned you record it in the computer with all necessary information; invoices are tracked & checked for accuracy against patient ledgers; statements are balanced with invoices & sent for payment quickly. You ensure that when applicable, cases are made in house to save on fees. You make sure that ProVerus approved labs are utilized whenever possible. Lab expense goal is <4.5% of Net Production (Production - Adjustments)
41	Patient Prescriptions - You are able to generate patient prescriptions from the computer at the Doctor's request; you have Dr. sign all prescriptions; you are willing to phone in prescriptions at the patient request & you always provide this as an option to the patient when handing them their prescription(s); you are familiar with what conditions require antibiotic prophylaxis; you provide premedication appropriately & always at the Dr.'s direction.
42	OSHA & HIPAA Compliance – You understands & follow all OSHA & HIPAA requirements & recommendations at all times; the sterilization area is clean & organized & always within OSHA guidelines ; treatment rooms are kept clean & clutter-free & always within OSHA guidelines; patient information is always held confidential & caution is made with regards to discussing protected information within the office.
43	Dental Supply Inventory Control – You are aware of an office budget for dental supplies; you are consiencious about usage & you minimize material waste; you inform the proper team member when supplies are running low; you follow the ordering process established; you keep treatment rooms stocked accordingly to help manage inventory. Clinical supply goal is <6.0% of Net Production (Production - Adjustments)
44	Instrument & Equipment Maintenance/Repair- You handle all instruments & dental equipment with care; you follow all maintenance recommendations timely & according to directions; you attend to faulty equipment immediately; you attempt to fix equipment within the office before contacting an outside repair company.
45	Office Production - Every team member contributes to the office's ability to produce and be profitable by the way they interact with patients and team members, their attention to detail, and their willingness to maintain a win/win mentality. If the office is more profitable, it can afford to pay team members more. Monthly Net Production (Production - Adjustments) Goal vs Actual. Office must be at goal to score a 2 and above goal to score a 3.					Goal $________ Current YTD $_______ Previous Year $_________
46	Office Collections - Collections is an intregal part of any business. All team members contribute to how much the office collects in different ways. The assistant contributes by ensuring that clinical notes are complete & accurate, handoffs are done every time, and that patient balances are checked at every visit. Monthly Net Collections (Collections - Refunds & NSFs) Goal vs Actual. Office must be at goal to score a 2 and above goal to score a 3.					Goal $________ Current YTD $_______ Previous Year $_________
47	Daily Preparation - You review the schedule with detail & scrutiny; you follow up on notes that are indicated; you look for opportunities throughout your day to provide extra services to patients; you are aware & prepared for possible disruptions in the schedule every day; you are familiar with goals & what is needed to reach/exceed those goals; you strategize with your team throughout the day on ways to increase production. You are prepared for the Morning Huddle - you know why the patient is there, what other treatment the patient needs or when their next cleaning is scheduled, and if their case is in. You make sure rooms and trays are set-up.
48	Daily Maintenance Tasks - You make sure trash is taken out, water bottles are filled, computers & clinical equipment is shutdown, and compressors have oil & are shut off before leaving. You make sure the office & restrooms are clean and ready for patients before they arrive for the day.
50	AVERAGE PERFORMANCE RATING	0.00
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52	0 - 0.99	Below Expectations				1.76 - 2.5		Meets Expectations
53	1.0 - 1.75	Add'l Development Needed				2.6 - 3.0		Exceeds Expectations
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55	Pay increases are based upon the following:
56	The Practice's ability to support the increase. This is determined by analyzing the current labor percentages in the practice & overall practice profitability.
57	Individual job performance & overall contributions to the team. This is determined by the results of the team member's performance assessment.
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60	Pay Raise Indicated?
61	Increase %:				From:		To:	$ -
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63	PLAN OF ACTION FOR PERFORMANCE IMPROVEMENT
64	Below is an Action Plan provided for you to improve in all areas that currently do not Meet Expectations of your job position. Failure to show a commitment to improvement may prompt a more serious discussion of your desire to keep your current position.
65	Follow Up Meeting scheduled for:
66	Action Plan for Improvement on any area scored less than 2:
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69	Dr. and/or Manager Comments:
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72	Employee Comments:
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75	Employee's Signature:	____________________________________
76	Dr. and/or Manager's Signature:	____________________________________
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