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 set challenging goals.
You help others to improve or meet standards of performance.
You are determined to complete tasks regardless of obstacles that may occur.
You set challenging goals for the department.
You schedule time for self and others to optimize high priority and long term actions. Monitors progress towards business goals.
Results Oriented	Agree	Unsure	Disagree	N/A
You stay focused on meeting the needs of customers.
You demonstrate the personal confidence to "stay the course," even when faced with difficulty
You encourage a high-energy, fun work environment and coaches others on how to do the same
You inspire and motivates co-workers to be productive and energetic at work
You explain the "whys" behind organizational objectives
Excellence	Agree	Unsure	Disagree	N/A
You demonstrate the functional or technical skills necessary to do your job.
You are planful and organized.
You keep yourself and others focused on constant improvement.
You demonstrate the analytical skills to do your job.
You take a lot of pride in your work.
Interpersonal Skills	Agree	Unsure	Disagree	N/A
You use tact, compassion, and sensitivity in interactions with others.
You successfully resolve conflicts and grievances to a win-win solution.
You express appreciation of other's work.
You anticipate the concerns of other employees.
You value the opinions of others.
Passion To Learn	Agree	Unsure	Disagree	N/A
You are open to feedback from others.
You create an environment that supports personal development and exploration.
You take initiative for own learning and development.
You enjoy learning new skills and techniques.
You inspire others to learn new things.
Continual Improvement	Agree	Unsure	Disagree	N/A
You analyze processes to determine areas for improvement.
You search for new methods, techniques, and processes that increase efficiency and reduce costs.
You look for ways to expand and learn new job skills.
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 delegate tasks effectively
You keep staff informed about what is happening in the company
You make others feel enthusiastic about your work
You are ready to offer help
You set an example for others to follow
Persuasion and Influence	Agree	Unsure	Disagree	N/A
You attempt to persuade others rather than simply control them.
You ensure stakeholders are involved in the decision making process.
You are able to express own goals and needs.
You develop a good rapport with others.
You persuade others to consider alternative points of view.
Goals	Agree	Unsure	Disagree	N/A
You make sure that team members have a clear idea of our group's goals.
You set high expectations and goals; encourages others to support the organization.
You achieve established goals.
You understand and contribute to development of strategic goals.
You conduct timely follow-up; keeps others informed on a need to know basis.
Customer Focus	Agree	Unsure	Disagree	N/A
I make sure team members understand the issues faced by the customer.
You set an example for excellent customer relations.
I am committed to the customer's success.
You build trust with the customer.
You maintain positive customer relationships.
Partnering/Networking	Agree	Unsure	Disagree	N/A
You support and encourage relationships that are created by diverse team members.
You maintain infrastructure to support partnerships and networks.
You collaborate with others to accomplish goals and objectives.
You seek to reduce institutional roadblocks to information sharing.
You create value within the Company by building networks.
Business Acumen	Agree	Unsure	Disagree	N/A
You understand complex issues and problems.
You understand financial terminology, statements.
I describe and summarize data.
You have a good understanding of liabilities and assets.
I have an understanding of various asset classes and how to interpret balance sheets.
Strategic Insight	Agree	Unsure	Disagree	N/A
You implement long-term solutions to problems.
You identify root causes of problems.
You create strategies that significantly benefit the Company.
You anticipate business cycles and trends and makes adjustments in a timely manner.
You formulate policies and strategies for addressing the Company's important challenges.
Planning	Agree	Unsure	Disagree	N/A
I can initiate the planning process by defining the scope of the project.
I make strategic and tactical decisions to guide the logistics process.
You are able to develop logistics plans to move material through a multi-step supply chain.
You are able to closely follow the plan established for the department.
I can develop strategic plans for ensuring competitiveness in the marketplace.

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.