Review Self Reflection

Name*

First Last

Position*

Personal (non-work) E-Mail*

To receive a copy of this form entry

Section 1: Looking Back

1. What accomplishment are you most proud of since your last review?

2. What has been your biggest challenge or frustration over the last six months?

3. What is one thing we do well as a practice that we should continue doing?

4. If you could improve one process, policy, or aspect of our workplace, what would it be and why?

Section 2: Team & Workplace

5. How would you describe accountability within your department?*

Very strong	Generally strong	Needs improvement	Significant improvement needed

Optional: Tell us more.

6. As part of our annual feedback process, we’d like to better understand what matters most to the team when it comes to our office schedule, patient access, team experience, practice growth, and maintaining consistent hours for the team. What type of schedule structure do you feel works best for the office long term?*

Keep the current schedule	Earlier start / earlier finish while maintaining consistent hours	Four longer days	Earlier weekday finish with Friday coverage	Later start / later finish	Other: please explain

6. Other (please explain)

Section 3: Growth & Development

7. What's one skill, area of knowledge, or responsibility you'd like to develop next?

8. Looking ahead to the next 6-12 months, what are your goals at 425 Dental?

Section 4: Looking Forward

9. If you were responsible for creating next year's work schedule, what would you keep the same and what would you change?

10. Is there anything you'd like us to know before your review meeting?

Scale Questions 1 (low score/not meeting expectations) - 10 (highest score/exceeding expectations)

A rating of 1 to 6 equates to below expectations, a 7 or 8 equates to meeting expectations, and a 9 or 10 equates to exceeding expectations.

1. How would you rate yourself in performing your current role? Explain and give examples.*

1) Explain and give examples.*

2. How would others in the practice rate your interactions with the others in the team? Explain and give examples.*

2) Explain and give examples.*

3. Rate your attendance over the last 6 months, and explain your rating.*

3) Explain and give examples.*

4. Rate how your behaviors align with 425 Dental’s Core Values. Provide examples of areas of success and growth.*

4) Explain and give examples.*

5. What outside hobbies/interests are you excited in pursuing?*

6. What does your future at 425 look like in your eyes?*

7. Where are you being challenged the most at 425?*

8. Where are you excelling the most at 425?*

9. What have you done since the last meeting to grow and exceed in your current position?*

10. What do you feel like we are doing right?*

11. What do you feel we are doing wrong?*

12. What do you feel like we should be doing that we aren’t doing right now?*

13. Do you understand all the benefits and how to utilize them?*

14. Is there anything else you’d like for us to know?*

Self Evaluation and Performance Prep

Introduction:

Section 1: Looking Back

Section 2: Team & Workplace

Section 3: Growth & Development

Section 4: Looking Forward

Scale Questions 1 (low score/not meeting expectations) - 10 (highest score/exceeding expectations)

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