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
You search for opportunities and innovative ways to improve the organization.
I adequately fund innovation efforts to ensure their success.
You pursue innovative approaches to the current policies and procedures.
I analyze the competitive environment to determine where innovation would have the greatest impact.
You encourage a search for radical innovation opportunities to obtain major breakthroughs.
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 are clear about goals that need to be achieved.
You make sure employees understand why they were given certain assignments.
You communicate ideas and facts clearly and effectively in writing.
You check details thoroughly.
You clarify problems and their causes to help employees correct them.
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 and inspirational.
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 are contributing fully to the extent of your skills
You demonstrate enthusiasm and a willingness to learn new skills and knowledge
You seek opportunities for professional development.
You seek opportunities for continuous learning.
You encourage employees to take courses relevant to their job.
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 responsibility for making important decisions to employees.
I allow employees to take on more responsibilities.
I recognize the importance of a healthy work/life balance.
I encourage independent, original thinking and creative problem-solving.
I encourage employees to take the initiative when responding to an issue.
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 build working relationships with others across cultures.
You respect individual differences.
You work well with others from different cultural backgrounds.
You attend training seminars and conferences to increase skills in working with others globally.
You can effectively deliver presentations to international clients.
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.