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 are planful and organized.
You can be counted on to add value wherever you are involved.
You demonstrate the functional or technical skills necessary to do your job.
You produce high quality 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 are excellent at managing time.
You maintain self-control when personally criticized.
You make sure that employees understand and identify with the team's mission.
You function well under stress, deadlines, and/or significant workloads.
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 are a role model for quality practices and standards.
You ensure the hiring of employees that have a quality focus.
You make sure cleanliness standards are met to reduce the possibility of contamination.
You reflect on what is working and what could be improved.
You identify strategies and their associated risks to improve quality.
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 coordinate the work of a team by assigning tasks to other team members.
You rank the importance of tasks to make sure critical tasks are completed first.
You are aware of the deadlines for specific tasks/assignments.
You ensure that assignments are prioritized according to the needs of the department/company.
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 have excellent communication with customers.
I maintain up-to-date information regarding customer products.
I respond to the needs of the customer.
You anticipate problems that the customer may encounter.
I provide a responsive service that meets the needs of 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 decline bad ideas to avoid making poor decisions.
You fully grasp both party's interests and options.
You adjust methods to suit the current situation.
You collect information from various stakeholders, each with their own viewpoints, data, and interests.
You find shared interests and solutions that benefit all parties involved.
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 create deadlines for various components of the strategy.
I am effective in using strategic tools such as value chain analysis, business environment analysis, and competitor analysis.
I exploit resources and capabilities to strategically increase production and responsiveness.
You determine the best strategy for achieving elevated levels of performance.
I am effective in strategy formulation and execution.
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.