HTML Preview Dental Assisting Practicum Evaluation Form page number 2.
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Excellent
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Good
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Fair
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Poor
NA
D. Proficiency in preparing and delivering:
1. 4-handed techniques:
a. Passing and receiving instruments.
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b. Local anesthetic.
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c. Dental dam.
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d. Matrix bands.
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2. RADIOGRAPHS (*REQUIRED TASK): (Check which used _____Film ______Digital)
a. Exposure.
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b. Processing.
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c. Mounting.
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3. Dental materials:
a. ALGINATE (*REQUIRED TASK).
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b. Cements.
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c. Amalgam/ Composite.
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d. Sealants.
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e. Other materials (List types _________________________)
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E. Proficiency in laboratory procedures:
1. Pouring models.
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2. Trimming plaster models.
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3. Fabricating appliances (List types):
____________________________________________________
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Comments on this student’s Dental Assisting Skills:
IV. ASEPTIC TECHNIQUES
A. Performs tasks according to OSHA regulations:
1. Without breaking chain of asepsis at chairside.
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2. Disinfects operatory and sterilizes instruments .
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3. Disposes of sharps (waste) according to OSHA regulations.
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Comments on this student’s Aseptic Technique:
V. PROFICIENCY DURING DENTAL PROCEDURES
A. Demonstrates knowledge of dental procedures.
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B. Demonstrates ability to anticipate the needs of the dentist.
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C. Demonstrates knowledge of dental terminology.
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VI. BUSINESS PROCEDURES
A. Telephone etiquette.
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B. Filing.
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C. Use of computer/ fax/ copier for practice management.
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Other comments:
If you were hiring a dental assistant, would you employ this student? ______YES ______ NO (IF NO, WHY NOT?)
Dentist’s signature _______________________________________________ Date mailed or faxed _________________
NECC faculty signature ___________________________________________ Date of office visit ___________________