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 encourage open communication to ensure that all proposals are considered.
You challenge current procedures to develop other alternatives.
I ensure the workforce maintains cutting-edge technical competencies to support continuous innovation and growth.
You challenge assumptions about the way things work.
I ensure that employees feel safe to take risks and experiment without the fear of failure or retribution.
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 avoid stating unclear or conflicting goals.
You attend to the important details of a job or task.
You provide a clear vision for the future.
You clearly explains responsibilities to individuals.
You communicate ideas and facts clearly and effectively in writing.
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 conceive, implement and evaluate ideas.
You inspire creativity in your team.
You create a lot of new ideas.
You add value to the department/organization.
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 encourage employees to take courses relevant to their job.
You are contributing fully to the extent of your skills
You allow employees to fully participate in employee training and professional development.
You keep yourself up-to-date of technical/professional issues
You seek opportunities for professional development.
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 allow individuals to be responsible for their decisions.
I support the decisions of others even if those decisions may sometimes lead to mistakes.
I motivate and encourage employees to be successful in their jobs.
I create a culture where employees are recognized and rewarded for taking the initiative and making impactful choices.
I allow for flexibility in the working hours.
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 demonstrate a curiosity about diverse individuals and cultures.
You demonstrate working knowledge of global transactions.
You exemplify the skills of a global worker.
You set the example for team on importance of cultural awareness.
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.