Achievement - 360 Degree Feedback Survey Sample #8

Self-Assessment Instructions

You have been selected to complete a self-assessment questionnaire as part of a 360-degree feedback assessment. Your feedback is an important part of 's leadership development process. This tool is intended to gather broad feedback in the core competencies and role responsibilities that are important for the on-going success of our organization.

Respond to the assessment form based on your work experiences during the previous 12 months. Your responses will be merged with other people's feedback and presented to you in your on-going development. Comments from others will be shared anonymously, as written.

Method of use: As part of the review process, managers will receive feedback from peers and staff. It is recognized that not all participants will be able to assess an individual's performance in all areas. The feedback received will be utilized as input to the manager's performance and on-going development plan.

You may sign out at any time by pressing the Save button at the end of the form and then closing your browser. You may return later to pick up where you left off. When you are done, press the Complete button.



Please complete your response by .

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Achievement	Agree	Unsure	Disagree	N/A
I am able to reduce department expenses by 25 percent.
I can complete required training and certification.
You use established goals and performance measures to keep track of performance.
You make use of talents of others to help achieve a high level of performance.
You follow-up and take action when goals are not met to ensure better results in the future.
Results Oriented	Agree	Unsure	Disagree	N/A
I persist in seeking objectives despite obstacles or setbacks.
I work hard despite obstacles that impede progress.
I determine the best approach to achieving the expected results.
You hold yourself and others accountable for achieving results.
I prioritize tasks to best achieve the results.
Excellence	Agree	Unsure	Disagree	N/A
You take a lot of pride in your work.
You keep yourself and others focused on constant improvement.
You demonstrate the functional or technical skills necessary to do your job.
You can be counted on to add value wherever you are involved.
You demonstrate the analytical skills to do your job.
Interpersonal Skills	Agree	Unsure	Disagree	N/A
You are easily approachable.
You strive for win/win solutions
I follow up on inquiries in a timely manner.
I pay close attention to what is being communicated verbally and nonverbally.
You address critical customer issues in a timely manner.
Passion To Learn	Agree	Unsure	Disagree	N/A
You take advantage of training opportunities when they arise.
You embrace new technology and procedures.
You take initiative for own learning and development.
You enhance your value to the company through additional training and development.
You exhibit willingness to upgrade skills through additional training and education.
Continual Improvement	Agree	Unsure	Disagree	N/A
You look for ways to expand current job responsibilities.
You are open to the suggestions from others.
You encourage an employee culture of continuous improvement to seek out better ways of doing things.
You look for ways to expand and learn new job skills.
You search for new methods, techniques, and processes that increase efficiency and reduce costs.
Management	Agree	Unsure	Disagree	N/A
You keep staff informed about what is happening in the company
You are ready to offer help
You make others feel enthusiastic about your work
You delegate tasks effectively
You set an example for others to follow
Persuasion and Influence	Agree	Unsure	Disagree	N/A
You are able to express own goals and needs.
You understand what others need.
You ensure stakeholders are involved in the decision making process.
You attempt to persuade others rather than simply control them.
You communicate effectively with others.
Goals	Agree	Unsure	Disagree	N/A
You conduct timely follow-up; keeps others informed on a need to know basis.
You establish and document goals and objectives.
You make sure that team members have a clear idea of our group's goals.
You make sure that I have a clear idea of our group's goals.
You set high expectations and goals; encourages others to support the organization.
Customer Focus	Agree	Unsure	Disagree	N/A
You understand the needs of the customer.
You use feedback from the customer to help improve the customer's experience.
I fulfill commitments made to customers.
You satisfy customer needs.
You use feedback from customers to help improve services.
Partnering/Networking	Agree	Unsure	Disagree	N/A
I build alliances with others in the company.
You sustain existing partnerships guided by contracts and agreements.
You support a partnering/networking culture.
You promote the understanding of how the department affects the organization overall.
You promote awareness of interests in partnerships and networks.
Business Acumen	Agree	Unsure	Disagree	N/A
You accurately perceive potential risks to the business.
I recognize trends in underlying data.
I conduct thorough market research to understand industry trends, customer needs, and competitive landscapes.
You have conversations with customers and clients to get a better insight into their business needs.
You understand the costs, profits, markets, and added value of issues.
Strategic Insight	Agree	Unsure	Disagree	N/A
You meet with customers to gain insight into their core needs and how best to serve them.
You identify root causes of problems.
I pursue strategic alliances with valued partners.
I develop a strategic vision for the future.
You analyze unique issues or problems impacting the Company.
Planning	Agree	Unsure	Disagree	N/A
You establish a course of action for self and others to accomplish specific goals.
You set up and monitor timeframes and plans
I can initiate the planning process by defining the scope of the project.
You are able to clearly articulate the plan for the department/district.
You understand what materials will be required to successfully implement the plan.

71. Overall, please rate the effectiveness of [Participant Name Here].
    

    5- Very Effective 4- Effective 3- Neither 2- Ineffective 1- Very Ineffective

    
    
72. Strengths
    
    
    
73. Areas for Development
    
    
    
74. Please give any final comments or suggestions for [Participant Name Here]'s assessment.