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 work to eliminate unnecessary work or barriers that get in others' way.
You show by your actions that you trust in the positive intentions of others.
You visibly support and encourages diversity in style and background.
You build open and trusting relationships.
You treat all people fairly and with respect.
Flexibility	Agree	Unsure	Disagree	N/A
You are effective in incorporating new ideas.
You can handle changes without complaining.
You encourage others to adopt new procedures.
You are open to alternative ways to accomplish goals
You are open to the perspectives/viewpoints of others.
Continual Learning	Agree	Unsure	Disagree	N/A
You pursue professional development opportunities when they arise.
You take charge of your training and skills enhancement.
You set relevant learning objectives and goals.
You share best practices with others and learn from others.
You pursue learning that will enhance job performance.
Establishing Focus/Direction	Agree	Unsure	Disagree	N/A
You align the department's goals with the goals of the organization.
You maintain self-control when personally criticized.
You maintain focus when handling several problems or tasks simultaneously.
You make sure that employees understand how their work relates to organizational goals.
You set appropriate goals for employees.
Analytical	Agree	Unsure	Disagree	N/A
You identifiy opportunities for progress and innovation.
You use appropriate techniques to solve problems.
You prioritize various actions to be taken when solving a problem.
You select the appropriate techniques for analysis.
You identify the root cause of a problem.
Initiative	Agree	Unsure	Disagree	N/A
You coach others to foster an environment which can adapt quickly and willingly to rapid change.
You seek and utilize opportunities for continuous learning and self-development.
You immediately work to complete goals well before your deadline.
You go above and beyond the stated goals.
You take decisive action to address problems, following up with relevant team members and coaching them on how to improve.
Results Oriented	Agree	Unsure	Disagree	N/A
You provide clear expectations for employees.
You do not become distracted by non-issues or interruptions.
You stay focused on meeting the needs of customers.
You demonstrate the personal confidence to "stay the course," even when faced with difficulty
You help others when free-time is available.
Objectives	Agree	Unsure	Disagree	N/A
You encourage others to take on greater responsibility.
You are able to establish realistic goals.
You assure [Company] principles are understood, employed & pursued.
You organize and schedules events, activities, and resources.
You consistently provide me with timely feedback for improving my performance.
Interpersonal Skills	Agree	Unsure	Disagree	N/A
You value the opinions of others.
You provide constructive feedback in a way that fosters acceptance and development.
You use tact, compassion, and sensitivity in interactions with others.
You strive for win/win solutions
You create an atmosphere that supports the open expression of ideas
Client Focus	Agree	Unsure	Disagree	N/A
You maintain strong relationships with clients.
You are pro-active in dealing with clients and addressing your needs.
You look for opportunities that have a positive impact on Clients.
You form strong client relationships
You obtain feedback to ensure client needs are being met.
Co-worker Development	Agree	Unsure	Disagree	N/A
You take immediate action on poor performance
You set and clearly communicate expectations, performance goals, and measurements to others
You provide ongoing feedback to co-workers on your development progress
You adapt coaching and mentoring approach to meet the style or needs of individuals
You work to identify root causes of performance problems

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.