Excellence - 360 Degree Feedback Survey Sample #7

360 Feedback Survey

Self-Assessment Form Instructions

is administering a new web-based survey tool which is designed to gather broad feedback as it relates to core competencies and role responsibilities that are important for the on-going success of our organization. All Leadership Team Members will be participating at this time.

In this regard, you need to complete a self-assessment questionnaire form (below).
Your responses will be combined with the responses from your peers and direct reports. 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.

In responding to the assessment form, please think about your experiences working with this individual during the last twelve (12) months. Your responses will be merged with other people's feedback and presented to guide them in their on-going development. Comments will be shared anonymously, as written, with the manager, unless you indicate otherwise.

You are only being asked to rate 8 competencies. Each competency will have a variety of statements that are grouped by 4 Performance Levels. Click on the level that best describes this individual.

Please ensure that your submission is made between .

Excellence	Needs Improvement		Fully Proficient		Excels/ Role Model	Not Applicable
You take a lot of pride in your work.
You demonstrate the analytical skills to do your job.
You demonstrate the functional or technical skills necessary to do your job.
You produce high quality work.
You can be counted on to add value wherever you are involved.
If you were to make improvements in Excellence, what are your suggestions for how you can improve this?
Establishing Focus/Direction	Needs Improvement		Fully Proficient		Excels/ Role Model	Not Applicable
You stay focused even when under pressure and stress.
You maintain focus when handling several problems or tasks simultaneously.
You function well under stress, deadlines, and/or significant workloads.
You set appropriate goals for employees.
You help guide employees with prioritizing tasks.
If you were to make improvements in Establishing Focus/Direction, what are your suggestions for how you can improve this?
Quality	Needs Improvement		Fully Proficient		Excels/ Role Model	Not Applicable
I implement quality control feedback loops to enhance services and products.
I assess strengths and weaknesses of various quality initiatives.
You design effective quality control systems.
I maintain detailed instructions to ensure consistency and quality in the production line.
I create a culture of quality standards in the workplace.
If you were to make improvements in Quality, what are your suggestions for how you can improve this?
Juggling Multiple Responsibilities	Needs Improvement		Fully Proficient		Excels/ Role Model	Not Applicable
You spend the most time and effort on critical tasks first.
You prioritize tasks for efficiency.
You switch attention to more urgent tasks when necessary.
You begin tasks as soon as possible.
You determine which tasks are critical and which tasks are optional.
If you were to make improvements in Juggling Multiple Responsibilities, what are your suggestions for how you can improve this?
Customer Focus	Needs Improvement		Fully Proficient		Excels/ Role Model	Not Applicable
I prioritize customer issues based on urgency.
I create documents that meet the customer's specifications.
You ensure all customer commitments and requirements are met or exceeded.
You ensure customers are comfortable with the services provided.
I exhibit a positive attitude even when dealing with difficult customers.
If you were to make improvements in Customer Focus, what are your suggestions for how you can improve this?
Negotiation	Needs Improvement		Fully Proficient		Excels/ Role Model	Not Applicable
I establish a strong, cooperative atmosphere; defines expectations; and presents a well-structured agenda aligned with key priorities.
You are able to adapt to dynamic situations created by new information or unexpected challenges.
You effectively set the tone and agenda, create rapport, and build momentum at the start of negotiations.
You base arguments on objective standards or criteria, such as market value, legal standards, or expert opinions.
You identify goals and objectives desired as well as the strengths and weaknesses currently possessed.
If you were to make improvements in Negotiation, what are your suggestions for how you can improve this?
Strategic Focus	Needs Improvement		Fully Proficient		Excels/ Role Model	Not Applicable
I communicate the company's strategic goals and decisions to teams and departments.
I can develop a strategic plan for adapting the organization to better respond to external changes in the marketplace.
I monitor company performance and make adjustments to the strategic plan as needed.
You strategically position resources to meet the needs of field based employees.
I detect changes in the environment and updates the strategic plan to address new opportunities or threats.
If you were to make improvements in Strategic Focus, what are your suggestions for how you can improve this?

36. Strengths
    
    
    
37. Areas for Development
    
    
    
38. Please give any final comments or suggestions for [Participant Name Here]'s assessment.