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 are planful and organized.
You keep yourself and others focused on constant improvement.
You demonstrate the functional or technical skills necessary to do your job.
You demonstrate the analytical skills to do your job.
You take a lot of pride in your work.
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 maintain focus when handling several problems or tasks simultaneously.
You function well under stress, deadlines, and/or significant workloads.
You are excellent at managing time.
You make sure that employees understand how their work relates to organizational goals.
You set appropriate goals for employees.
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 assist quality control inspectors.
I competently and accurately analyze quality measures.
You present quality information and data in an easy to understand format.
You effectively work with Quality Control (QC) engineers.
I create quality improvement programs and processes.
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 can multitask while performing all of your other responsibilities and activities.
You organize tasks for the most efficient order of completion.
You are aware of the deadlines for specific tasks/assignments.
You assess current capabilities before committing to new requests from customers.
You coordinate the work of a team by assigning tasks to other team members.
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
You consistently model positive customer service attitudes.
You consider customers point of view when making decisions.
I prioritize customer issues based on urgency.
You help customers feel they are receiving services tailored specifically to their needs.
You received good feedback from 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
You demonstrate emotional stability to facilitate productive problem-solving and relationship building.
I engage in questioning to obtain necessary information and examine various alternatives.
You are able to control your emotional responses and correctly gauge the emotions of others.
You identify verbal and nonverbal cues to help interpret actions and messages.
You thoroughly understand the interests and possibilities of both sides.
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 make plans to handle unforeseen events that could impact the achievement of strategic goals.
I am effective in strategy formulation and execution.
You create values statements to ensure all employees are working under the same guiding principles.
I create a strategy to achieve departmental objectives.
I identify business strategies to strengthen competitive capabilities.
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.