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 make effective decisions
You make effective decisions, even when under pressure.
You display high energy and enthusiasm on consistent basis.
You motivate & supports others to gain skills
Performance	Definite Strength	Meets Standards	Needs Development	N/A
You shown significant improvement in job performance.
You work effectively in the department.
You produce quality
You have great overall performance
You set a high standard for job performance.
Flexibility	Definite Strength	Meets Standards	Needs Development	N/A
You adapt to circumstances as needed.
You are open to alternative ways to accomplish goals
You encourage others to adopt new procedures.
You identify new opportunities to achieve goals
You act decisively in frequently changing and uncertain environment.
Emotional Intelligence	Definite Strength	Meets Standards	Needs Development	N/A
You are able to manage your own emotions.
You are able to understand others' points of view.
You are able to control your own emotions.
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 coach others and provides feedback on the use of different oral communication styles for different audiences
You listen to others' points of view with an open mind
You deal with difficult situations calmly and confidently.
You check for understanding throughout conversations or group presentations/discussions
You are able to demonstrate persuasiveness in pursuit of objectives.
Persuasion and Influence	Definite Strength	Meets Standards	Needs Development	N/A
You have excellent influencing/negotiating skills.
You seek to obtain consensus or compromise.
You attempt to persuade others rather than simply control them.
You communicate effectively with others.
You understand what others need.
Goals	Definite Strength	Meets Standards	Needs Development	N/A
You establish and document goals and objectives.
You make sure that I have a clear idea of our group's goals.
You set challenging stretch goals
You understand and contribute to development of strategic 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 identify gaps between actual and needed technical competencies and provide recommendations for required training.
You support technical training and development of employees.
You support employee training and development initiatives regarding implementation of technology.
You apply complex rules and regulations to maintain optimal system performance.
You use technology in decision making and problem solving.
Partnering/Networking	Definite Strength	Meets Standards	Needs Development	N/A
You seek to reduce institutional roadblocks to information sharing.
You develop a sense of trust in subordinates so they can freely interact and share information with others.
You create value within the Company by building networks.
You maintain infrastructure to support partnerships and networks.
You collaborate with others to accomplish goals and objectives.
Teamwork	Definite Strength	Meets Standards	Needs Development	N/A
You apply knowledge of team behavior to help achieve organizational goals and objectives.
You create a climate that encourages team participation.
You communicate well with team members.
You coach team members
You relate to all kinds of people tactfully

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.