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 .

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Innovation	Needs Improvement		Fully Proficient		Excels/ Role Model	Not Applicable
I encourage innovation from all levels of employees.
I ensure that employees feel safe to take risks and experiment without the fear of failure or retribution.
I establish and monitors key performance indicators (KPIs) for innovation.
You champion changes within the organization.
You seek new ideas and adapts to changing environments.
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 clarify problems and their causes to help employees correct them.
You clearly explains responsibilities to individuals.
You make sure goals and objectives are clearly and thoroughly explained and understood.
You communicate with clarity and efficiency.
You write clear job descriptions for positions in the organization.
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
I produce novel and valuable solutions to problems.
You transform learning into creative output.
I support team-building and communication to foster a creative environment.
You are able to innovate valuable ideas for new products.
I connect with peers across functions to spark new thinking.
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 allow employees to fully participate in employee training and professional development.
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.
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 allow individuals to be responsible for their decisions.
You permit employees to take training to become more independent.
You let employees make their own decisions.
You support the decisions of others.
I allow employees to take on more responsibilities.
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 collaborate with others respectfully and effectively with other people regardless of differences in cultural backgrounds.
You volunteer for experiences and assignments abroad.
You understand and appreciate the perspectives offered by others with different cultural backgrounds.
You consider customers point of view when making decisions.
You respect individual differences.
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.