Goals - 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 .

Goals	Needs Improvement		Fully Proficient		Excels/ Role Model	Not Applicable
You set challenging stretch goals
You make sure that team members have a clear idea of our group's goals.
You make sure that I have a clear idea of our group's goals.
You achieve established goals.
You establish and document goals and objectives.
If you were to make improvements in Goals, what are your suggestions for how you can improve this?
Creativity	Needs Improvement		Fully Proficient		Excels/ Role Model	Not Applicable
You inspire creativity in your team.
You conceive, implement and evaluate ideas.
You are creative.
You create a lot of new ideas.
You develop solutions to challenging problems.
If you were to make improvements in Creativity, what are your suggestions for how you can improve this?
Punctuality	Needs Improvement		Fully Proficient		Excels/ Role Model	Not Applicable
You invoice clients on a timely basis.
You conduct appointments at scheduled start time.
You avoid making personal phone calls during working hours.
You start meetings on time.
You arrive to meetings on time.
If you were to make improvements in Punctuality, what are your suggestions for how you can improve this?
Company	Needs Improvement		Fully Proficient		Excels/ Role Model	Not Applicable
You impress upon others the important aspects of [Company].
You understand the use of [Company] products and services.
You express loyalty and dedication to [Company] in interactions with others.
You understand the "basics" as to how [Company] functions/operates.
You understand how decisions impact other business units beyond your immediate department of work group.
If you were to make improvements in Company, what are your suggestions for how you can improve this?
Global Perspective	Needs Improvement		Fully Proficient		Excels/ Role Model	Not Applicable
You apply knowledge of overseas markets.
You respect individual differences.
You are able to listen and understand others and discuss issues in a respectful way.
You have positive interactions with individuals from different cultures and backgrounds.
You consider customers point of view when making decisions.
If you were to make improvements in Global Perspective, what are your suggestions for how you can improve this?

26. Strengths
    
    
    
27. Areas for Development
    
    
    
28. Please give any final comments or suggestions for [Participant Name Here]'s assessment.