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 build upon the ideas and solutions of others.
You offer constructive improvements to existing systems.
You encourage open communication to ensure that all proposals are considered.
You foster a creative and innovative work environment.
You analyze current procedures and identify opportunities for improvement.
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 make sure goals and objectives are clearly and thoroughly explained and understood.
You clearly explain the vision and goals of the company.
You are clear about the roles and duties of team members.
You provide a clear vision for the future.
You attend to the important details of a job or task.
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 develop solutions to challenging problems.
You add value to the department/organization.
You are creative and inspirational.
You conceive, implement and evaluate ideas.
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 seek opportunities for professional development.
You keep yourself up-to-date of technical/professional issues
You allow employees to fully participate in employee training and professional development.
You seek opportunities for continuous learning.
You demonstrate enthusiasm and a willingness to learn new skills and knowledge
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 give employees autonomy to complete tasks on their own.
You give employees input into the decision making process.
You set clear goals for assignments.
You encourage others to obtain necessary skills and training.
You let employees make their own decisions.
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 understand how cultures differ and how these differences impact work behavior.
You are aware of the culture, behaviors, identities and beliefs of others.
You collaborate with others respectfully and effectively with other people regardless of differences in cultural backgrounds.
You communicate effectively on a multi-lingual basis.
You engage in problem solving with individuals outside of the country.
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.