Form Edit - Dental Health Services Portal

Employee Name
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Employee Name
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Employee Name
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Employee Name
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Job Title
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Job Title
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Job Title
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Job Title
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Job Title
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Job Title
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Department
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Department
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Department
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Department
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Time in Position
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Time in Position
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Time in Position
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Time in Position
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Time in Position
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Time in Position
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Time in Position
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Time in Position
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Date of Last Review
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Date of Last Review
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Date of Last Review
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Date of Last Review
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Date of Last Review
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Date of Last Review
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Date of Last Review
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Date of Last Review
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Date of Last Review
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Date of Last Review
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Review Date
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Review Date
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Review Date
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Review Date
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Review Date
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Date Hired
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Date Hired
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Date Hired
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Date Hired
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Period Covered by Review
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Reason for Review
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A

E

Reason for Review
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A

E

Reason for Review
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A

E

Reason for Review
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Answer:

A

E

Reason for Review
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A

E

Reason for Review
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A

E

Purpose of Review
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Subtext: The purpose of this performance evaluation is to provide summary feedback to staff members on their job performance, and to provide clear goals for development.

Purpose of Review
Instructions

Subtext: The purpose of this performance evaluation is to provide summary feedback to staff members on their job performance, and to provide clear goals for development.

Purpose of Review
Instructions

Subtext: The purpose of this performance evaluation is to provide summary feedback to staff members on their job performance, and to provide clear goals for development.

Purpose of Review
Instructions

Subtext: The purpose of this performance evaluation is to provide summary feedback to staff members on their job performance, and to provide clear goals for development.

Purpose of Review
Instructions

Subtext: The purpose of this performance evaluation is to provide summary feedback to staff members on their job performance, and to provide clear goals for development.

Purpose of Review
Instructions

Subtext: The purpose of this performance evaluation is to provide summary feedback to staff members on their job performance, and to provide clear goals for development.

Carefully evaluate employee\\\'s work performance in relation to the essential functions of the job. Check the rating box that best indicates employee\\\'s performance. Assign points for each rating within the scale and write that number in the corresponding points box. Points will be totaled and averaged for an overall performance score.
Instructions

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Carefully evaluate employee\\\'s work performance in relation to the essential functions of the job. Check the rating box that best indicates employee\\\'s performance. Assign points for each rating within the scale and write that number in the corresponding points box. Points will be totaled and averaged for an overall performance score.
Instructions

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Carefully evaluate employee\\\'s work performance in relation to the essential functions of the job. Check the rating box that best indicates employee\\\'s performance. Assign points for each rating within the scale and write that number in the corresponding points box. Points will be totaled and averaged for an overall performance score.
Instructions

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Carefully evaluate employee\\\'s work performance in relation to the essential functions of the job. Check the rating box that best indicates employee\\\'s performance. Assign points for each rating within the scale and write that number in the corresponding points box. Points will be totaled and averaged for an overall performance score.
Instructions

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Carefully evaluate employee\\\'s work performance in relation to the essential functions of the job. Check the rating box that best indicates employee\\\'s performance. Assign points for each rating within the scale and write that number in the corresponding points box. Points will be totaled and averaged for an overall performance score.
Instructions

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Carefully evaluate employee\\\'s work performance in relation to the essential functions of the job. Check the rating box that best indicates employee\\\'s performance. Assign points for each rating within the scale and write that number in the corresponding points box. Points will be totaled and averaged for an overall performance score.
Instructions

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Definitions of Performance Ratings (to be used in rating on the following pages)
Instructions

Subtext: (5) O-Outstanding- Performance is exceptional in all areas and is recognizable as being far superior to others. (4) V-Very Good- Results clearly exceed most position requirements. Performance is of high quality and is achieved on a consistent basis. (3) G- Good - Competent and dependable level of performance. Meets the performance standards of the job. (2) I- Improvement Needed - Performance is deficient in certain areas. Improvement is necessary. (1) U- Unsatisfactory- Results are generally unacceptable and require immediate improvement. No Merit increase should be granted to individuals with this rating.

Definitions of Performance Ratings (to be used in rating on the following pages)
Instructions

Subtext: (5) O-Outstanding- Performance is exceptional in all areas and is recognizable as being far superior to others. (4) V-Very Good- Results clearly exceed most position requirements. Performance is of high quality and is achieved on a consistent basis. (3) G- Good - Competent and dependable level of performance. Meets the performance standards of the job. (2) I- Improvement Needed - Performance is deficient in certain areas. Improvement is necessary. (1) U- Unsatisfactory- Results are generally unacceptable and require immediate improvement. No Merit increase should be granted to individuals with this rating.

Definitions of Performance Ratings (to be used in rating on the following pages)
Instructions

Subtext: (5) O-Outstanding- Performance is exceptional in all areas and is recognizable as being far superior to others. (4) V-Very Good- Results clearly exceed most position requirements. Performance is of high quality and is achieved on a consistent basis. (3) G- Good - Competent and dependable level of performance. Meets the performance standards of the job. (2) I- Improvement Needed - Performance is deficient in certain areas. Improvement is necessary. (1) U- Unsatisfactory- Results are generally unacceptable and require immediate improvement. No Merit increase should be granted to individuals with this rating.

Definitions of Performance Ratings (to be used in rating on the following pages)
Instructions

Subtext: (5) O-Outstanding- Performance is exceptional in all areas and is recognizable as being far superior to others. (4) V-Very Good- Results clearly exceed most position requirements. Performance is of high quality and is achieved on a consistent basis. (3) G- Good - Competent and dependable level of performance. Meets the performance standards of the job. (2) I- Improvement Needed - Performance is deficient in certain areas. Improvement is necessary. (1) U- Unsatisfactory- Results are generally unacceptable and require immediate improvement. No Merit increase should be granted to individuals with this rating.

I. Performance Factors
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Subtext: A. Professional Skills

I. Performance Factors
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Subtext: A. Professional Skills

I. Performance Factors
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Subtext: A. Professional Skills

I. Performance Factors
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Subtext: A. Professional Skills

I. Performance Factors
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Subtext: A. Professional Skills

I. Performance Factors
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Subtext: A. Professional Skills

Job Knowledge: Possess working knowledge of all phases of the job and the various techniques and skills necessary for efficient completion of tasks. Remains up to date on changes/trends in technical knowledge related to job. Expands knowledge of the job and company services as it relates to other positions.
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Min: 1 Max: 5

Job Knowledge: Possess working knowledge of all phases of the job and the various techniques and skills necessary for efficient completion of tasks. Remains up to date on changes/trends in technical knowledge related to job. Expands knowledge of the job and company services as it relates to other positions.
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Min: 1 Max: 5

Job Knowledge: Possess working knowledge of all phases of the job and the various techniques and skills necessary for efficient completion of tasks. Remains up to date on changes/trends in technical knowledge related to job. Expands knowledge of the job and company services as it relates to other positions.
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Min: 1 Max: 5

Job Knowledge: Possess working knowledge of all phases of the job and the various techniques and skills necessary for efficient completion of tasks. Remains up to date on changes/trends in technical knowledge related to job. Expands knowledge of the job and company services as it relates to other positions.
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Min: 1 Max: 5

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Job Knowledge: Ability to make sound and proper decisions by drawing on professional expertise with minimal negative effects of employee relations and/or departmental and company goals and results. Willingness to take responsibility for these decisions.
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Min: 1 Max: 5

Job Knowledge: Ability to make sound and proper decisions by drawing on professional expertise with minimal negative effects of employee relations and/or departmental and company goals and results. Willingness to take responsibility for these decisions.
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Min: 1 Max: 5

Job Knowledge: Ability to make sound and proper decisions by drawing on professional expertise with minimal negative effects of employee relations and/or departmental and company goals and results. Willingness to take responsibility for these decisions.
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Min: 1 Max: 5

Job Knowledge: Ability to make sound and proper decisions by drawing on professional expertise with minimal negative effects of employee relations and/or departmental and company goals and results. Willingness to take responsibility for these decisions.
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Min: 1 Max: 5

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B. Interactive Skills
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B. Interactive Skills
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B. Interactive Skills
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B. Interactive Skills
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B. Interactive Skills
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B. Interactive Skills
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B. Interactive Skills
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B. Interactive Skills
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1. Interpersonal Relationships: Demonstrates a willingness to cooperate, work and communicate with coworkers, supervisors, subordinated and/or outside contacts.
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Min: 1 Max: 5

1. Interpersonal Relationships: Demonstrates a willingness to cooperate, work and communicate with coworkers, supervisors, subordinated and/or outside contacts.
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Min: 1 Max: 5

1. Interpersonal Relationships: Demonstrates a willingness to cooperate, work and communicate with coworkers, supervisors, subordinated and/or outside contacts.
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Min: 1 Max: 5

1. Interpersonal Relationships: Demonstrates a willingness to cooperate, work and communicate with coworkers, supervisors, subordinated and/or outside contacts.
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Min: 1 Max: 5

1. Interpersonal Relationships: Demonstrates a willingness to cooperate, work and communicate with coworkers, supervisors, subordinated and/or outside contacts.
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Min: 1 Max: 5

1. Interpersonal Relationships: Demonstrates a willingness to cooperate, work and communicate with coworkers, supervisors, subordinated and/or outside contacts.
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Min: 1 Max: 5

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2. Communication: Effectiveness of expression in individual and group situations. Ability to convey ideas clearly and concisely.
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Min: 1 Max: 5

2. Communication: Effectiveness of expression in individual and group situations. Ability to convey ideas clearly and concisely.
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Min: 1 Max: 5

2. Communication: Effectiveness of expression in individual and group situations. Ability to convey ideas clearly and concisely.
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Min: 1 Max: 5

2. Communication: Effectiveness of expression in individual and group situations. Ability to convey ideas clearly and concisely.
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Min: 1 Max: 5

2. Communication: Effectiveness of expression in individual and group situations. Ability to convey ideas clearly and concisely.
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Min: 1 Max: 5

2. Communication: Effectiveness of expression in individual and group situations. Ability to convey ideas clearly and concisely.
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Min: 1 Max: 5

2. Communication: Effectiveness of expression in individual and group situations. Ability to convey ideas clearly and concisely.
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Min: 1 Max: 5

2. Communication: Effectiveness of expression in individual and group situations. Ability to convey ideas clearly and concisely.
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Min: 1 Max: 5

2. Communication: Effectiveness of expression in individual and group situations. Ability to convey ideas clearly and concisely.
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Min: 1 Max: 5

2. Communication: Effectiveness of expression in individual and group situations. Ability to convey ideas clearly and concisely.
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Min: 1 Max: 5

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C. Administrative Skills
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C. Administrative Skills
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C. Administrative Skills
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C. Administrative Skills
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C. Administrative Skills
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C. Administrative Skills
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1. Coordination: Ability to work with others as a team and express individual viewpoint while considering and learning from the input of others.
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Min: 1 Max: 5

1. Coordination: Ability to work with others as a team and express individual viewpoint while considering and learning from the input of others.
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Min: 1 Max: 5

1. Coordination: Ability to work with others as a team and express individual viewpoint while considering and learning from the input of others.
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Min: 1 Max: 5

1. Coordination: Ability to work with others as a team and express individual viewpoint while considering and learning from the input of others.
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Min: 1 Max: 5

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2. Planning and Organization: Establishes appropriate course of action for self and subordinates to accomplish goals. Makes proper assignments of personnel and appropriate use of resources. Sets realistic target dates.
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Min: 1 Max: 5

2. Planning and Organization: Establishes appropriate course of action for self and subordinates to accomplish goals. Makes proper assignments of personnel and appropriate use of resources. Sets realistic target dates.
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Min: 1 Max: 5

2. Planning and Organization: Establishes appropriate course of action for self and subordinates to accomplish goals. Makes proper assignments of personnel and appropriate use of resources. Sets realistic target dates.
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Min: 1 Max: 5

2. Planning and Organization: Establishes appropriate course of action for self and subordinates to accomplish goals. Makes proper assignments of personnel and appropriate use of resources. Sets realistic target dates.
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Min: 1 Max: 5

2. Planning and Organization: Establishes appropriate course of action for self and subordinates to accomplish goals. Makes proper assignments of personnel and appropriate use of resources. Sets realistic target dates.
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Min: 1 Max: 5

2. Planning and Organization: Establishes appropriate course of action for self and subordinates to accomplish goals. Makes proper assignments of personnel and appropriate use of resources. Sets realistic target dates.
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Min: 1 Max: 5

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3. Adherence to Policies and Procedures: Properly interprets and applies company and departmental policies and procedures to job responsibilities.
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Min: 1 Max: 5

3. Adherence to Policies and Procedures: Properly interprets and applies company and departmental policies and procedures to job responsibilities.
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Min: 1 Max: 5

3. Adherence to Policies and Procedures: Properly interprets and applies company and departmental policies and procedures to job responsibilities.
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Min: 1 Max: 5

3. Adherence to Policies and Procedures: Properly interprets and applies company and departmental policies and procedures to job responsibilities.
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Min: 1 Max: 5

3. Adherence to Policies and Procedures: Properly interprets and applies company and departmental policies and procedures to job responsibilities.
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Min: 1 Max: 5

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4. Orientation Toward Results: Ability to initiate projects, anticipate changes or needs, set new priorities, follow through and meet deadlines.
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Min: 1 Max: 5

4. Orientation Toward Results: Ability to initiate projects, anticipate changes or needs, set new priorities, follow through and meet deadlines.
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Min: 1 Max: 5

4. Orientation Toward Results: Ability to initiate projects, anticipate changes or needs, set new priorities, follow through and meet deadlines.
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Min: 1 Max: 5

4. Orientation Toward Results: Ability to initiate projects, anticipate changes or needs, set new priorities, follow through and meet deadlines.
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Min: 1 Max: 5

4. Orientation Toward Results: Ability to initiate projects, anticipate changes or needs, set new priorities, follow through and meet deadlines.
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Min: 1 Max: 5

4. Orientation Toward Results: Ability to initiate projects, anticipate changes or needs, set new priorities, follow through and meet deadlines.
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Min: 1 Max: 5

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II. Performance Expectations
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Subtext: List and comment on four major performance expectations you had for the employee during the current review period. Specify how well the employee supported.reached your expectations. Consider quality, quantity and impact on department objectives and operating results.

II. Performance Expectations
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Subtext: List and comment on four major performance expectations you had for the employee during the current review period. Specify how well the employee supported.reached your expectations. Consider quality, quantity and impact on department objectives and operating results.

II. Performance Expectations
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Subtext: List and comment on four major performance expectations you had for the employee during the current review period. Specify how well the employee supported.reached your expectations. Consider quality, quantity and impact on department objectives and operating results.

II. Performance Expectations
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Subtext: List and comment on four major performance expectations you had for the employee during the current review period. Specify how well the employee supported.reached your expectations. Consider quality, quantity and impact on department objectives and operating results.

1. Performance Expectation
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1. Performance Expectation
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1. Performance Expectation
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1. Performance Expectation
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1. Performance Expectation
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Supervisors Comments:
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1. Performance Expectation:
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1. Performance Expectation:
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1. Performance Expectation:
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1. Performance Expectation:
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1. Performance Expectation:
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1. Performance Expectation:
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2. Performance Expectation
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2. Performance Expectation
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2. Performance Expectation
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2. Performance Expectation
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2. Performance Expectation
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2. Performance Expectation
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2. Performance Expectation
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2. Performance Expectation
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2. Performance Expectation
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2. Performance Expectation
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2. Performance Expectation
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2. Performance Expectation
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Supervisors Comments:
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2. Performance Expectation:
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Min: 1 Max: 5

2. Performance Expectation:
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2. Performance Expectation:
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2. Performance Expectation:
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2. Performance Expectation:
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Min: 1 Max: 5

3. Performance Expectation
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3. Performance Expectation
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3. Performance Expectation
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3. Performance Expectation
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3. Performance Expectation
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Supervisors Comments:
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3. Performance Expectation:
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Min: 1 Max: 5

3. Performance Expectation:
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3. Performance Expectation:
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3. Performance Expectation:
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3. Performance Expectation:
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3. Performance Expectation:
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3. Performance Expectation:
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3. Performance Expectation:
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3. Performance Expectation:
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3. Performance Expectation:
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3. Performance Expectation:
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3. Performance Expectation:
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3. Performance Expectation:
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3. Performance Expectation:
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3. Performance Expectation:
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Min: 1 Max: 5

3. Performance Expectation:
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Min: 1 Max: 5

4. Performance Expectation
Long Answer

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4. Performance Expectation
Long Answer

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4. Performance Expectation
Long Answer

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4. Performance Expectation
Long Answer

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4. Performance Expectation
Long Answer

Subtext:

Supervisors Comments:
Long Answer

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Supervisors Comments:
Long Answer

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Supervisors Comments:
Long Answer

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Supervisors Comments:
Long Answer

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4. Performance Expectation:
Numeric Answer

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Min: 1 Max: 5

4. Performance Expectation:
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4. Performance Expectation:
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4. Performance Expectation:
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Min: 1 Max: 5

4. Performance Expectation:
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Min: 1 Max: 5

III. Rate Overall Performance
Instructions

Subtext: Total Points/Number of Factors Rated= Overall Rating

III. Rate Overall Performance
Instructions

Subtext: Total Points/Number of Factors Rated= Overall Rating

III. Rate Overall Performance
Instructions

Subtext: Total Points/Number of Factors Rated= Overall Rating

III. Rate Overall Performance
Instructions

Subtext: Total Points/Number of Factors Rated= Overall Rating

III. Rate Overall Performance
Instructions

Subtext: Total Points/Number of Factors Rated= Overall Rating

Numeric Calculation

Subtext: This Value will be calculated when the form is first saved.

Formula: sum

Question: numeric_answer, Weight:

Numeric Calculation

Subtext: This Value will be calculated when the form is first saved.

Formula: sum

Question: numeric_answer, Weight:

Numeric Calculation

Subtext: This Value will be calculated when the form is first saved.

Formula: sum

Question: numeric_answer, Weight:

Numeric Calculation

Subtext: This Value will be calculated when the form is first saved.

Formula: sum

Question: numeric_answer, Weight:

Numeric Calculation

Subtext: This Value will be calculated when the form is first saved.

Formula: sum

Question: numeric_answer, Weight:

IV. Accomplishments and Contributions
Instructions

Subtext:

IV. Accomplishments and Contributions
Instructions

Subtext:

IV. Accomplishments and Contributions
Instructions

Subtext:

IV. Accomplishments and Contributions
Instructions

Subtext:

Describe the accomplishments and contributions the employee made during the review period in areas other than those covered by specific objectives.
Long Answer

Subtext:

Describe the accomplishments and contributions the employee made during the review period in areas other than those covered by specific objectives.
Long Answer

Subtext:

Describe the accomplishments and contributions the employee made during the review period in areas other than those covered by specific objectives.
Long Answer

Subtext:

Describe the accomplishments and contributions the employee made during the review period in areas other than those covered by specific objectives.
Long Answer

Subtext:

Describe the accomplishments and contributions the employee made during the review period in areas other than those covered by specific objectives.
Long Answer

Subtext:

Describe the accomplishments and contributions the employee made during the review period in areas other than those covered by specific objectives.
Long Answer

Subtext:

V. Major Strengths
Instructions

Subtext:

V. Major Strengths
Instructions

Subtext:

V. Major Strengths
Instructions

Subtext:

V. Major Strengths
Instructions

Subtext:

V. Major Strengths
Instructions

Subtext:

V. Major Strengths
Instructions

Subtext:

V. Major Strengths
Instructions

Subtext:

Describe at least 3 major employee strengths.
Long Answer

Subtext:

Describe at least 3 major employee strengths.
Long Answer

Subtext:

Describe at least 3 major employee strengths.
Long Answer

Subtext:

Describe at least 3 major employee strengths.
Long Answer

Subtext:

Describe at least 3 major employee strengths.
Long Answer

Subtext:

VI. Areas Needing Improvement
Instructions

Subtext:

VI. Areas Needing Improvement
Instructions

Subtext:

VI. Areas Needing Improvement
Instructions

Subtext:

VI. Areas Needing Improvement
Instructions

Subtext:

VI. Areas Needing Improvement
Instructions

Subtext:

Describe any areas needing improvement.
Long Answer

Subtext:

Describe any areas needing improvement.
Long Answer

Subtext:

Describe any areas needing improvement.
Long Answer

Subtext:

Describe any areas needing improvement.
Long Answer

Subtext:

Describe any areas needing improvement.
Long Answer

Subtext:

Describe any areas needing improvement.
Long Answer

Subtext:

Describe any areas needing improvement.
Long Answer

Subtext:

Describe any areas needing improvement.
Long Answer

Subtext:

Describe any areas needing improvement.
Long Answer

Subtext:

Describe any areas needing improvement.
Long Answer

Subtext:

Describe any areas needing improvement.
Long Answer

Subtext:

VII. Training and Development
Instructions

Subtext:

VII. Training and Development
Instructions

Subtext:

VII. Training and Development
Instructions

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VII. Training and Development
Instructions

Subtext:

VII. Training and Development
Instructions

Subtext: