Action - 360 Degree Feedback Survey Sample #9

360 Feedback Survey

Self-Assessment Instructions

Thank you for agreeing to participate in this leadership training process. As part of this process, you will be completing the self-assessment questionnaire (below). As you respond, please draw on your work experiences over the past 12 months. Rate each item using the scale shown. Comments at the end can help you to explain your ratings. If you gave a particularly high or low rating, please share your reasons in the comment section for that competency. Your responses will be compiled with feedback from others and presented to you at the next leadership seminar to help guide your ongoing professional development.

Partially completed forms can be saved by using the Save/Still Working button at the bottom of the page. You may return at a later time to complete/edit the form. Your saved responses will be shown each time you re-visit the feedback form. When you are certain that you have completed your responses and will be not making any changes, click the Complete button.

Action	Definite Strength	Meets Standards	Needs Development	N/A
You drive and mobilizes others progress toward goals.
You do whatever it takes (within reason) to get the job done.
You make effective decisions
You get the job done.
You work quickly when faced with difficult problems.
Performance	Definite Strength	Meets Standards	Needs Development	N/A
You work well in this position.
You effectively organize resources and plans
You produce quality
You are effective in performing your job.
You have great overall performance
Flexibility	Definite Strength	Meets Standards	Needs Development	N/A
You identify new opportunities to achieve goals
You are open to alternative ways to accomplish goals
You adapt to new organizational structures, policies, or procedures.
You are willing to try new ideas.
You work effectively during periods of change.
Emotional Intelligence	Definite Strength	Meets Standards	Needs Development	N/A
You are able to control your own emotions.
You help employees to resolve conflicts, communicate clearly, and work together to solve problems.
You are attentive to emotional cues and interprets others' feelings correctly.
You accurately perceive the emotional reactions of others.
You are able to express yourself clearly.
Communication Skills	Definite Strength	Meets Standards	Needs Development	N/A
You deal with difficult situations calmly and confidently.
You communicate effectively with all levels of the organization.
You an effective listener who is responsive to information needs.
You deliver information in a clear, concise, and logical manner.
You communicate with department leadership
Persuasion and Influence	Definite Strength	Meets Standards	Needs Development	N/A
You ensure stakeholders are involved in the decision making process.
You persuade others to consider alternative points of view.
You are able to express own goals and needs.
You seek to obtain consensus or compromise.
You develop a good rapport with others.
Goals	Definite Strength	Meets Standards	Needs Development	N/A
You achieve goals.
You establish and document goals and objectives.
You achieve established goals.
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.
Technology Use/Management	Definite Strength	Meets Standards	Needs Development	N/A
You are proficient in the use of technical systems and processes.
You support employee training and development initiatives regarding implementation of technology.
You understand and are committed to implementing new technologies.
You adopt the implementation of new technology into the workplace.
You apply complex rules and regulations to maintain optimal system performance.
Partnering/Networking	Definite Strength	Meets Standards	Needs Development	N/A
You promote the understanding of how the department affects the organization overall.
You create value within the Company by building networks.
You develop a sense of trust in subordinates so they can freely interact and share information with others.
You create the conditions for partnerships to grow and develop.
You partner with peers to obtain influence within the Company.
Teamwork	Definite Strength	Meets Standards	Needs Development	N/A
You identify and resolves conflicts within the team to increase team effectiveness
You recognize and respects the contributions and needs of each individual.
You seek and listen to other's contributions
You encourage collaboration with other departments.
You come across as a reliable, committed team member

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

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

    
    
52. Strengths
    
    
    
53. Areas for Development
    
    
    
54. Please give any final comments or suggestions for [Participant Name Here]'s assessment.