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 demonstrate the functional or technical skills necessary to do your job.
You demonstrate the analytical skills to do your job.
You produce high quality work.
You are planful and organized.
You keep yourself and others focused on constant improvement.
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 self-control when personally criticized.
You make sure that employees understand and identify with the team's mission.
You maintain focus when handling several problems or tasks simultaneously.
You align the department's goals with the goals of the organization.
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
You correct issues in a timely manner.
You reflect on what is working and what could be improved.
You encourage others to achieve high quality standards.
You encourage others to produce the highest quality work products.
You analyze what occurred and re-adjusts accordingly when goals are not met.
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 determine which tasks are critical and which tasks are optional.
You coordinate the work of a team by assigning tasks to other team members.
You switch attention to more urgent tasks when necessary.
You integrate developing others with driving sales, serving customers, merchandising, performing operational procedures, and maintaining an appealing store environment.
You observe, analyze, and respond to merchandise needs while serving customers and accomplishing operational tasks.
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 create customized solutions for the customer.
You do not hesitate to address customer concerns or complaints.
I act with integrity in all customer interactions.
You anticipate problems that the customer may encounter.
You provide excellent service to 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 are able to say "no" when necessary to effectively execute business strategy and meet long-term objectives.
You are able to decline bad ideas to avoid making poor decisions.
You maintain good interpersonal relationships with representatives from the other party.
You research the needs of the other party to identify strengths and weaknesses of positions.
You actively listen to conversations to be able to recall important details later.
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
You sustain or achieves a competitive advantage for the organization by analyzing the best practices and lessons learned from other organizations.
You communicate goals and objectives to employees.
You understand your role within the organization.
You understand and contribute to development of strategic goals.
You focus attention on treating the causes of problems rather than simply addressing the symptoms.
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.