Attitude - 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 .

Attitude	Agree	Unsure	Disagree	N/A
You visibly support and encourages diversity in style and background.
You contribute to a positive and fun work environment.
You treat all people fairly and with respect.
You show by your actions that you trust in the positive intentions of others.
You build open and trusting relationships.
Flexibility	Agree	Unsure	Disagree	N/A
You are effective in incorporating new ideas.
You adapt to circumstances as needed.
You identify new opportunities to achieve goals
You are able to adapt to new situations.
You encourage others to adopt new procedures.
Continual Learning	Agree	Unsure	Disagree	N/A
You take charge of your training and skills enhancement.
You share best practices with others and learn from others.
You are open to new ideas and concepts.
You take the initiative to learn new skills.
You build on your strengths while addressing your weaknesses.
Establishing Focus/Direction	Agree	Unsure	Disagree	N/A
You stay focused even when under pressure and stress.
You maintain focus when handling several problems or tasks simultaneously.
You set appropriate goals for employees.
You maintain self-control when personally criticized.
You align the department's goals with the goals of the organization.
Analytical	Agree	Unsure	Disagree	N/A
You identify problems and issues needing resolution.
You balance risks and costs with the reward and probabilities of success when decisions.
You identifiy opportunities for progress and innovation.
You identify the root cause of a problem.
You select the appropriate techniques for analysis.
Initiative	Agree	Unsure	Disagree	N/A
When working on a problem in a team, I often am the first to suggest possible solutions.
You seize upon opportunities available.
I seize upon chances to improve the department's prospects.
I immediately work on solving problems.
I inspire others to perform above expectations.
Results Oriented	Agree	Unsure	Disagree	N/A
You work toward achievement of goals even when confronted with obstacles.
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 do not become distracted by non-issues or interruptions.
You stay focused on meeting the needs of customers.
Objectives	Agree	Unsure	Disagree	N/A
You establish goals and objectives.
You consistently provide me with timely feedback for improving my performance.
You effectively organize resources and plans
You are able to organize work.
You set long-term and short-term goals.
Interpersonal Skills	Agree	Unsure	Disagree	N/A
You demonstrate compassion and understanding of others.
You use tact, compassion, and sensitivity in interactions with others.
You effectively manage conflicts by dealing with them directly and immediately
You demonstrate willingness to work with others.
You are a role model for others
Client Focus	Agree	Unsure	Disagree	N/A
I identify opportunities that enhance the client's experience.
I provide a responsive service that meets the needs of clients.
You received good feedback from clients.
I act with integrity in all client interactions.
I accept responsibility for ensuring client satisfaction.
Co-worker Development	Agree	Unsure	Disagree	N/A
You work to identify root causes of performance problems
You give others development opportunities through project assignments and increased job responsibilities
You adapt coaching and mentoring approach to meet the style or needs of individuals
You set and clearly communicate expectations, performance goals, and measurements to others
You provide ongoing feedback to co-workers on your development progress

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

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

    
    
57. Strengths
    
    
    
58. Areas for Development
    
    
    
59. Please give any final comments or suggestions for [Participant Name Here]'s assessment.