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 .

Achievement	Agree	Unsure	Disagree	N/A
You are determined to complete tasks regardless of obstacles that may occur.
You take reasonable risks to achieve desired results.
You establish stretch goals to advance skills and output.
You are driven to complete goals despite obstacles that may arise.
I was able to increase production by 20 percent.
Results Oriented	Agree	Unsure	Disagree	N/A
I promptly and efficiently complete assigned tasks.
You stay focused on solving problems and getting work done.
You inspire and motivates co-workers to be productive and energetic at work
You explain the "whys" behind organizational objectives
You are willing to take on new assignments to help increase production.
Excellence	Agree	Unsure	Disagree	N/A
You keep yourself and others focused on constant improvement.
You demonstrate the analytical skills to do your job.
You are planful and organized.
You take a lot of pride in your work.
You demonstrate the functional or technical skills necessary to do your job.
Interpersonal Skills	Agree	Unsure	Disagree	N/A
I build strong relationships with team members.
You strive to lead by example to demonstrate the value of interpersonal relationships.
I demonstrate a high degree of ethics and integrity in the workplace.
You build a strong rapport with co-workers.
You are trusted by peers and co-workers; others are willing to confide in him/her
Passion To Learn	Agree	Unsure	Disagree	N/A
You create an environment that supports personal development and exploration.
You exhibit willingness to upgrade skills through additional training and education.
You enhance your value to the company through additional training and development.
You will participate in training classes even if offered outside of normal working hours.
You take initiative for own learning and development.
Continual Improvement	Agree	Unsure	Disagree	N/A
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.
You promote training and development opportunities to enhance job performance.
You encourage an employee culture of continuous improvement to seek out better ways of doing things.
You are open to the suggestions from others.
Management	Agree	Unsure	Disagree	N/A
You make others feel enthusiastic about your work
You take responsibility for things that go wrong
You delegate tasks effectively
You are ready to offer help
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 have excellent influencing/negotiating skills.
You persuade others to consider alternative points of view.
You ensure stakeholders are involved in the decision making process.
You develop a good rapport with others.
Goals	Agree	Unsure	Disagree	N/A
You make sure that I have a clear idea of our group's goals.
You make sure that team members have a clear idea of our group's goals.
You understand and contribute to development of strategic goals.
You achieve goals.
You conduct timely follow-up; keeps others informed on a need to know basis.
Customer Focus	Agree	Unsure	Disagree	N/A
You maintain strong relationships with customers.
You follow up with any unanswered questions from the customer.
I am transparent in all communications with the customer.
I build long term relationships with customers.
I identify opportunities that enhance the customer's experience.
Partnering/Networking	Agree	Unsure	Disagree	N/A
I maintain communication channels with colleagues in the industry.
I nurture a collaborative and inclusive environment that encourages knowledge sharing and continuous learning.
You strive to cultivate and sustain trustful and committed relationships with all partners.
I develop effective peer to peer working relationships.
You capitalize on partnerships and networks to enhance the Company's bottom line.
Business Acumen	Agree	Unsure	Disagree	N/A
You anticipate marketplace opportunities and supports speed to market.
You are up-to-date with regulatory guidelines and policies.
You create strategic plans that conform with regulations and industry guidelines.
You consider impact of actions on other areas of the organization.
I understand cash flow procedures and statements.
Strategic Insight	Agree	Unsure	Disagree	N/A
You anticipate business cycles and trends and makes adjustments in a timely manner.
You ommunicate with employees to find out their needs.
You understand the Company's strengths and weaknesses and uses this information to create optimal solutions to problems.
You maintain knowledge of current trends in the industry.
You work with others to develop insights into the resources and actions required to produce desired results.
Planning	Agree	Unsure	Disagree	N/A
I set the appropriate sequence of tasks to ensure completion of the project.
I am able to stay organized and focused using excellent planning skills.
I reduce uncertainty in the department through clear planning and schedules.
I can initiate the planning process by defining the scope of the project.
I conduct regular assessments of the project status to ensure adherence to the set schedule.

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.