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 produce high quality work.
You keep yourself and others focused on constant improvement.
You are planful and organized.
You can be counted on to add value wherever you are involved.
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 stay focused even when under pressure and stress.
You make sure that employees understand and identify with the team's mission.
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
You encourage others to achieve high quality standards.
You hold employees accountable for your quality of work.
You analyze what occurred and re-adjusts accordingly when goals are not met.
You reflect on what is working and what could be improved.
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 use a scheduler/planner to keep tasks organized and on time.
You plan and organize continuously while performing all other responsibilities and activities.
You avoid bottlenecks in progress by assigning multiple individuals to critical tasks.
You observe, analyze, and respond to merchandise needs while serving customers and accomplishing operational tasks.
You recognize and respond to product placement and signing needs while staying alert to customers' needs, store activities and training associates.
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 maintain positive customer relationships.
You consistently model positive customer service attitudes.
You develop good rapport and trust with the customer.
You consider customers point of view when making decisions.
You develop strong customer relationships.
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 stay calm and focus on the core issues to be discussed.
You establish good working relationships with others.
You understand the expectations of other parties in the negotiation.
You are able to clearly express thoughts and concerns.
You identify verbal and nonverbal cues to help interpret actions and messages.
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 plans to develop and promote organizational and area strengths, as well as to address weaknesses.
You understand your role within the organization.
You look for opportunities to enhance contributions to the bottom line.
You focus attention on treating the causes of problems rather than simply addressing the symptoms.
You communicate goals and objectives to employees.
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.