Continual Improvement - 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 .

Continual Learning	Agree	Unsure	Disagree	N/A
You share best practices with others and learn from others.
You pursue self-improvement through continual learning.
You set relevant learning objectives and goals.
You improve on your skill sets.
You take the initiative to learn new skills.
Continual Improvement	Agree	Unsure	Disagree	N/A
You encourage an employee culture of continuous improvement to seek out better ways of doing things.
You are open to the suggestions from others.
You promote training and development opportunities to enhance job performance.
You search for new methods, techniques, and processes that increase efficiency and reduce costs.
You look for ways to improve work processes and procedures.
Establishing Focus/Direction	Agree	Unsure	Disagree	N/A
You make sure that employees understand how their work relates to organizational goals.
You maintain focus when handling several problems or tasks simultaneously.
You stay focused even when under pressure and stress.
You make sure that employees understand and identify with the team's mission.
You set appropriate goals for employees.
Analytical	Agree	Unsure	Disagree	N/A
You use appropriate techniques to solve problems.
You analyze issues and reduces them to your component parts.
You prioritize various actions to be taken when solving a problem.
You identify the root cause of a problem.
You identifiy opportunities for progress and innovation.
Initiative	Agree	Unsure	Disagree	N/A
You immediately work to complete goals well before your deadline.
You take decisive action to address problems, following up with relevant team members and coaching them on how to improve.
You seek and utilize opportunities for continuous learning and self-development.
You go above and beyond the stated goals.
You coach others to foster an environment which can adapt quickly and willingly to rapid change.
Flexibility	Agree	Unsure	Disagree	N/A
You are able to adapt to new situations.
You can handle changes without complaining.
You adapt to circumstances as needed.
You encourage others to adopt new procedures.
You identify new opportunities to achieve goals
Objectives	Agree	Unsure	Disagree	N/A
You work toward achieving established goals and objectives.
You consistently provide me with timely feedback for improving my performance.
You establish goals and objectives.
You encourage others to take on greater responsibility.
You communicate goals and objectives to employees.
Empowering Others	Agree	Unsure	Disagree	N/A
You set clear goals for assignments.
You are aware of the skill levels of others.
You give employees input into the decision making process.
You set clear goals for others to accomplish.
You allow employees to make their own decisions.
Others	Agree	Unsure	Disagree	N/A
You form working relationships with employees from other departments.
You consistently demonstrate ability and willingness to trust others.
You constructively receive criticism and suggestions from others.
You respect the opinions of other employees.
You include others in the decision making processes.
Entrepreneurship	Agree	Unsure	Disagree	N/A
You maintain a high level of energy to respond to demands of the job.
You encourage dynamic growth opportunities.
You are comfortable operating in an environment of uncertainty.
You exhibit determination and passion in completion of goals.
You can work effectively in an environment of uncertainty.

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.