Innovation - 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 .

Innovation	Needs Improvement		Fully Proficient		Excels/ Role Model	Not Applicable
You challenge current procedures to develop other alternatives.
You offer constructive improvements to existing systems.
You suggest new ideas at meetings.
You create a safe environment for idea-sharing.
You solve problems with insight and understanding.
If you were to make improvements in Innovation, what are your suggestions for how you can improve this?
Clarity	Needs Improvement		Fully Proficient		Excels/ Role Model	Not Applicable
You check details thoroughly.
You clearly explain the vision and goals of the company.
You write clear job descriptions for positions in the organization.
You are clear about goals that need to be achieved.
You make sure goals and objectives are clearly and thoroughly explained and understood.
If you were to make improvements in Clarity, what are your suggestions for how you can improve this?
Creativity	Needs Improvement		Fully Proficient		Excels/ Role Model	Not Applicable
You are creative.
You are creative and inspirational.
You conceive, implement and evaluate ideas.
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?
Professional Development	Needs Improvement		Fully Proficient		Excels/ Role Model	Not Applicable
You quickly acquire and apply new knowledge and skills when needed
You encourage employees to take courses relevant to their job.
You demonstrate enthusiasm and a willingness to learn new skills and knowledge
You seek opportunities for professional development.
You keep yourself up-to-date of technical/professional issues
If you were to make improvements in Professional Development, what are your suggestions for how you can improve this?
Empowering Others	Needs Improvement		Fully Proficient		Excels/ Role Model	Not Applicable
You demonstrate confidence in the abilities of subordinates.
You trust employees are able to complete assigned tasks.
You encourage others to obtain necessary skills and training.
You avoid micromanaging your employees.
You express confidence in the abilities of others.
If you were to make improvements in Empowering Others, what are your suggestions for how you can improve this?
Global Perspective	Needs Improvement		Fully Proficient		Excels/ Role Model	Not Applicable
You work well with others from different cultural backgrounds.
You understand global systems such as the global economy.
You are able to work with individuals having different backgrounds and cultures.
You collaborate with others respectfully and effectively with other people regardless of differences in cultural backgrounds.
You attend training seminars and conferences to increase skills in working with others globally.
If you were to make improvements in Global Perspective, what are your suggestions for how you can improve this?

31. Strengths
    
    
    
32. Areas for Development
    
    
    
33. Please give any final comments or suggestions for [Participant Name Here]'s assessment.