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 find creative ways to get things done with limited resources.
You search for opportunities and innovative ways to improve the organization.
You foster a creative and innovative work environment.
You implement best practices within the department.
You encourage open communication to ensure that all proposals are considered.
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 employees understand why they were given certain assignments.
You seek to reduce ambiguity in messaging and documents.
You are clear about the roles and duties of team members.
You attend to the important details of a job or task.
You communicate with clarity and efficiency.
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 inspire creativity in your team.
You create a lot of new ideas.
You develop solutions to challenging problems.
You are creative and inspirational.
You add value to the department/organization.
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 keep yourself up-to-date of technical/professional issues
You are contributing fully to the extent of your skills
You quickly acquire and apply new knowledge and skills when needed
You demonstrate enthusiasm and a willingness to learn new skills and knowledge
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
I encourage employees to take the initiative when responding to an issue.
I value the input from others.
I coordinate the knowledge, skills and resources of others to accomplish more in the department.
You set clear goals for assignments.
I consider ideas from employees that may challenge traditional ways of doing the job.
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 are able to work with individuals having different backgrounds and cultures.
You develop both the cultural awareness and business skills to grow our business in all countries, and work effectively across borders with employees, customers, and shareowners.
You cooperate with others on a global scale.
You align personal vision with global strategies.
You are aware of the culture, behaviors, identities and beliefs of others.
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.