Commitment to Result - 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 .

Commitment To Result	Agree	Unsure	Disagree	N/A
You convey strong sense of own pride in Company to associates by creating a shared vision around sales and customer service.
You are able to focus on a task even when working alone.
You encourage commitment in others to obtain results.
You coordinate all department activities into a cohesive team effort.
You are committed to the team.
Establishing Focus/Direction	Agree	Unsure	Disagree	N/A
You are excellent at managing time.
You maintain focus when handling several problems or tasks simultaneously.
You maintain self-control when personally criticized.
You set appropriate goals for employees.
You make sure that employees understand how their work relates to organizational goals.
Strategic Focus	Agree	Unsure	Disagree	N/A
You let employees know how their roles contribute toward the achievement of strategic company objectives.
You communicate goals and objectives to employees.
I create innovative strategies.
I develop strategies to increase efficiency and reduce environmental impacts.
You make sure the objectives are clearly communicated and understood.
Flexibility	Agree	Unsure	Disagree	N/A
You implement changes as a result of having listened to employees
You identify new opportunities to achieve goals
You adapt to new organizational structures, policies, or procedures.
You encourage others to adopt new procedures.
You are open to the perspectives/viewpoints of others.
Passion To Learn	Agree	Unsure	Disagree	N/A
You hold self and associates accountable for goal achievement.
You take advantage of training opportunities when they arise.
You inspire others to learn new things.
You will participate in training classes even if offered outside of normal working hours.
You demonstrate a willingness to participate in continuing education courses.
Cultural Awareness	Agree	Unsure	Disagree	N/A
I am aware of differences in how individuals from other cultures greet one another.
I participate in cultural training sessions/classes.
I am effective in working with individuals with a variety of cultural backgrounds.
I help other employees to become more culturally sensitive.
I value the diverse perspectives from others.
Administrative Skill	Agree	Unsure	Disagree	N/A
You have strong organizational skills to keep the workspace and department in order
You complete reports on-time.
You have strong technical/computer skills.
You implement and use performance measures.
You accurately implement contract provisions.
Innovation	Agree	Unsure	Disagree	N/A
You encourage open communication to ensure that all proposals are considered.
You suggest new ideas at meetings.
You offer constructive improvements to existing systems.
You analyze current procedures and identify opportunities for improvement.
You take risks to advance important ideas.
Objectives	Agree	Unsure	Disagree	N/A
You consistently provide me with timely feedback for improving my performance.
You are able to establish realistic goals.
You organize and schedules events, activities, and resources.
You work toward achieving established goals and objectives.
You effectively organize resources and plans
Empowering Others	Agree	Unsure	Disagree	N/A
You trust employees are able to complete assigned tasks.
You give employees the freedom to set their own schedule.
You provide support and resources needed to accomplish goals.
You give employees the opportunity to make their own decisions at work.
I encourage independent, original thinking and creative problem-solving.
Partnering/Networking	Agree	Unsure	Disagree	N/A
You partner with peers to obtain influence within the Company.
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 capitalize on partnerships and networks to enhance the Company's bottom line.
You maintain infrastructure to support partnerships and networks.
Entrepreneurship	Agree	Unsure	Disagree	N/A
You are comfortable operating in an environment of uncertainty.
You maintain a high level of energy to respond to demands of the job.
You can work effectively in an environment of uncertainty.
You balance risks and rewards when making decisions.
You encourage risk taking for developing potential business opportunities.

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

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

    
    
62. Strengths
    
    
    
63. Areas for Development
    
    
    
64. Please give any final comments or suggestions for [Participant Name Here]'s assessment.