SIOUXLAND COMMUNITY HEALTH CENTER SIOUX CITY, IOWA

PERFORMANCE EVALUATION-COMPETENCY

Employee: Position: Dental Assistant Department Dental Services Date: Rating for: ___ 90 day Probation ___ Extended Probation ___ Annual ___ Special Review Rating: +2 = Exemplary Performance +1 = Exceeds Criteria 0 = Meets Criteria -1 = Partially Met Criteria -2 = Unsatisfactory Score of -2 requires comments written in “Comments/Action Plan”. Essential Responsibilities Measurable Behaviors +2 +1 0 -1 -2 Comments/Action Plans

A. Demonstrates ability to

perform the general functions of the position.

a.

B. & C. Accountable for maintaining and updating specific knowledge and competence.

1. Maintains BCLS certificates. 2. Obtains CEU’s to maintain current Dental

Assistant and/or Radiology certification. 3. Assures CEU certificates are given to

Personnel Department.

D. Responsible to demonstrate dependability as an employee through flexibility, punctuality and attendance.

1. Observes work hours and time clock regulations.

2. Consistently punctual in reporting to work and to and from work breaks.

3. Maintains a good attendance record, keeping absenteeism at a minimum.

4. Demonstrates flexibility in staffing and work practices and supports cross training as patient/customer needs require.

5. Regularly attends department meetings. 6. Participates in mandatory inservices as

stipulated by the department and/or SCHC.

E. Responsible to demonstrate initiative and judgment

1. Demonstrates self-motivation and the ability to work independently.

2. Demonstrates the ability to comply with established policies and procedures.

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3. Demonstrates good time management in

the completion of job functions. 4. Demonstrates sound judgment and

composure in response to emotional or emergent situations.

5. Demonstrates good judgment through characteristics of appropriate personal appearance and personal hygiene.

6. Assists Clinical Supervisors with development and updating of policies and procedures.

F. Demonstrates the ability to work with coworkers, patients, visitors and other members of the healthcare team.

1. Able to communicate effectively with all ages served (newborn, pediatric, adolescent, adult and geriatric) as applicable.

2. Demonstrates the ability to work in a team environment, reaffirming the contribution of each person to the delivery of care/services.

3. Promotes/maintains positive inter and intra department relations.

4. Participates in department/SCHC committees as applicable

G. Complies with SCHC ethical standards

1. Required to comply with SCHC ethical standards.

2. Demonstrates stewardship in the performance of daily business operations through accuracy of work and compliance with regulations.

3. Demonstrates knowledge of the SCHC personnel manual.

4. Demonstrates knowledge of SCHC

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policies, procedures and manuals pertinent to department.

H. Responsible to obtain and maintain knowledge of measures to ensure self, patient, family and coworker safety.

1. Demonstrates knowledge of safety/security measures in the Environment of Care (responds to tornado, fire, violence, bomb threats).

2. Practices safe work habits. • Ergonomics (back safety, repetitive

action) • Environmental Safety Surveillance • Hazardous Materials • Utility Management • Infection Control Practices (Standard

Precautions) 3. Demonstrates ability to employ effective

coping mechanisms to deal with emotional situations.

I. Contributes to the mission, vision and values of the SCHC.

1. Demonstrates respect for the dignity and integrity of each person with courtesy and compassion while respecting cultural differences.

2. Demonstrates efficient, high-quality and cost effective services in a thorough, efficient, caring and knowledgeable manner providing family-centered holistic care.

3. Demonstrates quality care that is mission-driven, accessible, patient-oriented and fulfills our responsibility to meet the health care needs of the Siouxland community.

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4. Manages information in a professional,

private and confidential manner. Note: Enter average of each section below, then average A through I for total score. A B-C D E F G H I Total Score = 0 + 1 + 2 = Meets Expectations -1 -2 = Does not meet expectations Supervisor Goals or Recommendations: Employee Comment or Self-Goals: Retain on Probation: YES NO N/A Evaluation Completed: YES NO Date: Next Evaluation Date: Employee Signature Date Department Manager Signature Date