(Migrated from the comments at request of OP.)
One place to look is in the following source:
National Research Council. Evaluating and Improving Undergraduate Teaching in Science, Technology, Engineering, and Mathematics. Washington, DC: The National Academies Press, 2003.
There is free online access, and Chapter 5 (Evaluation Methodologies), includes a section specifically on Self-Evaluation for STEM instructors at the undergraduate level.
Chapter 6 (Evaluation of Individual Faculty: Criteria and Benchmarks) may be worth a read, as well.
For more information on the book, see the Executive Summary and Background on Committee Members.