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 find creative ways to get things done with limited resources.
You encourage open communication to ensure that all proposals are considered.
You foster a creative and innovative work environment.
You build upon the ideas and solutions of others.
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 clearly explain the vision and goals of the company.
You check details thoroughly.
You make sure employees understand why they were given certain assignments.
You use appropriate grammar and tense in communications.
You clearly define work objectives for employees.
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 develop solutions to challenging problems.
You create a lot of new ideas.
You inspire creativity in your team.
You conceive, implement and evaluate ideas.
You are creative.
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 seek opportunities for continuous learning.
You encourage employees to take courses relevant to their job.
You demonstrate enthusiasm and a willingness to learn new skills and knowledge
You quickly acquire and apply new knowledge and skills when needed
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 create a culture where employees are given the opportunity to take the initiative and make impactful decisions.
I give new tasks to employees.
You demonstrate confidence in the abilities of subordinates.
I acknowledge and appreciate employees for their proactive decision-making.
I value the input from 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 facilitate open communication with individuals from other countries.
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 have positive interactions with individuals from different cultures and backgrounds.
You set the example for team on importance of cultural awareness.
You work well with others from different cultural backgrounds.
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.