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 can be counted on to add value wherever you are involved.
You keep yourself and others focused on constant improvement.
You demonstrate the functional or technical skills necessary to do your job.
You are planful and organized.
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 stay focused even when under pressure and stress.
You set appropriate goals for employees.
You maintain self-control when personally criticized.
You are excellent at managing time.
You function well under stress, deadlines, and/or significant workloads.
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 always strive to produce the highest quality work products.
You encourage others to produce the highest quality work products.
You hold employees accountable for your quality of work.
You encourage employees to produce the best quality products.
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 rank the importance of tasks to make sure critical tasks are completed first.
You determine which tasks are critical and which tasks are optional.
You avoid bottlenecks in progress by assigning multiple individuals to critical tasks.
You manage impact of increased traffic flow and freight receipt by detailed planning of controllables and by anticipating and reacting positively to uncontrollables.
You complete multiple tasks simultaneously.
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 identify the most pressing needs of each customer.
I am available to respond to customer needs.
I promptly respond to customers.
You look for opportunities that have a positive impact on customers.
I respond to 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 are able to control your emotional responses and correctly gauge the emotions of others.
You establish clear communications to avoid misunderstandings.
You establish good working relationships with others.
You conduct necessary preparations before engaging in negotiations.
You are able to decline bad ideas to avoid making poor decisions.
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 implement and execute the company's strategy for advancing production capabilities.
You strategically deploy resources to areas of the greatest need.
I pursue strategic alliances with valued partners.
You caft and execute strategies to advance the company.
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.