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Dental Assistant Peer Evaluation Form

Lets the dental team rate a colleague's performance point by point in a structured, constructive way.

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Page 1

Instructions: rate your teammate's performance in each category using the star scale.

Team Member*

Next, rate your colleague across each of the following performance areas.

Page 2

1. Reliability — Are you there for the team? Do you call in often?*

★ 1 star ★ 2 stars ★ 3 stars ★ 4 stars ★ 5 stars

If you rated below 3 stars, please add a comment or example explaining why

Page 3

2. Punctuality — Do you arrive on time and ready for the day?*

★ 1 star ★ 2 stars ★ 3 stars ★ 4 stars ★ 5 stars

Additional comment

Page 4

3. Appearance — Do you present a professional look and follow uniform guidelines?*

★ 1 star ★ 2 stars ★ 3 stars ★ 4 stars ★ 5 stars

If you rated below 3 stars, please add a comment or example explaining why

Page 5

4. Team player — Do you take the initiative to help others on your care team and the wider team?*

★ 1 star ★ 2 stars ★ 3 stars ★ 4 stars ★ 5 stars

If you rated below 3 stars, please add a comment or example explaining why

Page 6

5. Approachability — Are you easy to talk to and do you take constructive feedback well?*

★ 1 star ★ 2 stars ★ 3 stars ★ 4 stars ★ 5 stars

If you rated below 3 stars, please add a comment or example explaining why

Page 7

6. Productivity — Do you stay busy and find tasks to do when you're not with a patient?*

★ 1 star ★ 2 stars ★ 3 stars ★ 4 stars ★ 5 stars

Additional comment

Page 8

7. Self-accountability — Do you own your mistakes, correct them, and apply the lesson going forward?*

★ 1 star ★ 2 stars ★ 3 stars ★ 4 stars ★ 5 stars

If you rated below 3 stars, please add a comment or example explaining why

Page 9

8. Attitude — Do you keep a positive attitude and stay away from negativity and gossip?*

★ 1 star ★ 2 stars ★ 3 stars ★ 4 stars ★ 5 stars

If you rated below 3 stars, please add a comment or example explaining why

Page 10

9. Operatory appearance — Do you keep your treatment room clean, organized, and presentable for patients?*

★ 1 star ★ 2 stars ★ 3 stars ★ 4 stars ★ 5 stars

If you rated below 3 stars, please add a comment or example explaining why

Page 11

10. Patient communication — Do you follow scripting guidelines and clearly explain treatment and post-op instructions?*

★ 1 star ★ 2 stars ★ 3 stars ★ 4 stars ★ 5 stars

Additional comment

Page 12

11. OSHA/CDC compliance — Do you follow protocols, disinfect properly, and practice good safety measures?*

★ 1 star ★ 2 stars ★ 3 stars ★ 4 stars ★ 5 stars

If you rated below 3 stars, please add a comment or example explaining why

Page 13

12. Flexibility — Are you willing to work with another team, location, or doctor, and step up when the team is short-staffed?

★ 1 star ★ 2 stars ★ 3 stars ★ 4 stars ★ 5 stars

If you rated below 3 stars, please add a comment or example explaining why

Page 14

Additional feedback (this is a chance to reflect on anything you're working on or need more training for)

Page 15

Your Name*

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