This document contains a teacher evaluation/self-assessment form with 8 domains: Planning, Management, Instruction, Professional Development, School Improvement, Evaluation, Interpersonal Relationships, and Professional Attitude and Conduct. Each domain contains a list of examples of standards and is rated on a scale of 1 to 5. The form also includes spaces for comments on each domain from the evaluator. It will be used to evaluate a teacher on their performance.