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 produce high quality work.
You are planful and organized.
You demonstrate the functional or technical skills necessary to do your job.
You demonstrate the analytical skills to do your job.
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
I monitor the workload balance and impact on employees.
You review organizational conditions to uncover strategic opportunities and mitigate potential threats.
You recognize and reinforce behaviors that meet or exceed established standards.
I establish processes and structure to steer the organization in a clear, strategic direction.
You anticipate potential challenges or obstacles that might derail department plans.
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.
I quickly identify critical issues impacting quality.
You present quality information and data in an easy to understand format.
I inspire others to achieve high quality standards.
I identify appropriate sources of quality standards.
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 switch attention to more urgent tasks when necessary.
You assess current capabilities before committing to new requests from customers.
You avoid bottlenecks in progress by assigning multiple individuals to critical tasks.
You are aware of the deadlines for specific tasks/assignments.
You plan and organize continuously while performing all other responsibilities and activities.
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
I make customers feel valued by acknowledging their concerns and validate their experiences.
You document customer interactions.
I exhibit a positive attitude even when dealing with difficult customers.
You address customer complaints immediately.
You make sure your interests are aligned with the customer's interests.
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
I keep a firm grasp on the issues and priorities.
I listen to all sides without bias and make fair decisions.
I foster a robust, collaborative setting; sets clear expectations; and introduces an agenda that matches priorities.
You influence others through rational argument and persuasion.
You know the current business/market environment.
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
I develops strategies to effectively use company resources and exploit potential opportunities.
You avoid complacency and strives to be ahead of changes in the business environment.
I identify and address strategic risks impacting operations.
You are able to formulate strategy at the corporate level.
You create values statements to ensure all employees are working under the same guiding principles.
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.