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 .

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Excellence	Needs Improvement		Fully Proficient		Excels/ Role Model	Not Applicable
You keep yourself and others focused on constant improvement.
You demonstrate the analytical skills to do your job.
You produce high quality work.
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 set appropriate goals for employees.
You function well under stress, deadlines, and/or significant workloads.
You align the department's goals with the goals of the organization.
You stay focused even when under pressure and stress.
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
I effectively coordinate with other departments to improve quality.
You consistently provide timely, accurate, and reliable information on quality measures.
You establish timeframes for achieving suitable quality levels.
You hold employees accountable for your quality of work.
I understand and use established quality procedures/controls.
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 keep track of multiple assignments and deadlines.
You assign tasks based on skills of team members.
You integrate developing others with driving sales, serving customers, merchandising, performing operational procedures, and maintaining an appealing store environment.
You plan and organize continuously while performing all other responsibilities and activities.
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 provide a high level of service to customers.
You build trust with the customer.
I prioritize customer issues based on urgency.
You promote, implement, maintain and enhances relationships with customers.
I create documents that meet the customer's specifications.
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 maintain control over emotions to ensure a constructive environment.
You maintain good interpersonal relationships with representatives from the other party.
You are able to manage and resolve conflicts constructively.
I stay composed and counter aggressive negotiation tactics by reframing unreasonable proposals or actions.
I am aware of wht problems need to be solved.
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 make sure the objectives are clearly communicated and understood.
I develop high-level strategic planning models to identify opportunities to improve the company.
I identify sources for developing a global competitive advantage for the company.
I implement and execute the company's strategy for advancing production capabilities.
I strategically focus efforts to improve operational efficiencies.
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.