Objectives - 360 Degree Feedback Survey Sample #8

Self-Assessment Instructions

You have been selected to complete a self-assessment questionnaire as part of a 360-degree feedback assessment. Your feedback is an important part of 's leadership development process. 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.

Respond to the assessment form based on your work experiences during the previous 12 months. Your responses will be merged with other people's feedback and presented to you in your on-going development. Comments from others will be shared anonymously, as written.

Method of use: As part of the review process, managers will receive feedback from peers and staff. It is recognized that not all participants will be able to assess an individual's performance in all areas. The feedback received will be utilized as input to the manager's performance and on-going development plan.

You may sign out at any time by pressing the Save button at the end of the form and then closing your browser. You may return later to pick up where you left off. When you are done, press the Complete button.



Please complete your response by .

Objectives	Agree	Unsure	Disagree	N/A
You work toward achieving established goals and objectives.
You consistently provide me with timely feedback for improving my performance.
You set long-term and short-term goals.
You assure [Company] principles are understood, employed & pursued.
You encourage others to take on greater responsibility.
Achievement	Agree	Unsure	Disagree	N/A
You take calculated risks to achieve higher levels of performance.
You are driven to complete assignments on time.
I am able to reduce department expenses by 25 percent.
You demonstrate a sense of urgency to quickly and accurately solve problems and issues.
I can complete training on the new equipment.
Establishing Focus/Direction	Agree	Unsure	Disagree	N/A
You set appropriate goals for employees.
You align the department's goals with the goals of the organization.
You make sure that employees understand and identify with the team's mission.
You maintain self-control when personally criticized.
You are excellent at managing time.
Innovation	Agree	Unsure	Disagree	N/A
You create a safe environment for idea-sharing.
You create improved methods or solutions for meeting goals and objectives.
You challenge current procedures to develop other alternatives.
You foster a creative and innovative work environment.
You build upon the ideas and solutions of others.
Interpersonal Skills	Agree	Unsure	Disagree	N/A
You strive to lead by example to demonstrate the value of interpersonal relationships.
You communicate well at all levels of the organization.
I follow up on inquiries in a timely manner.
You effectively manage conflicts by dealing with them directly and immediately
I maintain a high degree of honesty and integrity.
Responsible	Agree	Unsure	Disagree	N/A
You are a person others can trust.
Your behavior is ethical and honest.
You work in a way that makes others want to work with you.
You are responsible for setting the vision of the department.
You set a good example
Coaching	Agree	Unsure	Disagree	N/A
You coach employees in how to strengthen knowledge and skills to improve work performance.
You help employees to maintain high personal standards.
You provide clear, motivating, and constructive feedback.
You develop the skills and capabilities of others.
You conduct regular performance appraisals and feedback.
Others	Agree	Unsure	Disagree	N/A
You treat others with respect and dignity.
You treat others with respect and dignity.
You are able to see issues from others' perspectives.
You work effectively with people from other departments.
You form working relationships with employees from other departments.
Cultural Awareness	Agree	Unsure	Disagree	N/A
You support and mentor others that may have different cultural backgrounds.
I seek knowledge and information about other cultures.
I help other employees to become more culturally sensitive.
I actively listen to other employees' stories about their culture.
You respect others regardless of age, race, gender, nationality, or disability.
Global Perspective	Agree	Unsure	Disagree	N/A
You analyze global issues/problems that are having a large impact on the Company.
You engage in problem solving with individuals outside of the country.
You facilitate open communication with individuals from other countries.
You collaborate with others respectfully and effectively with other people regardless of differences in cultural backgrounds.
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.

51. Overall, please rate the effectiveness of [Participant Name Here].
    

    5- Very Effective 4- Effective 3- Neither 2- Ineffective 1- Very Ineffective

    
    
52. Strengths
    
    
    
53. Areas for Development
    
    
    
54. Please give any final comments or suggestions for [Participant Name Here]'s assessment.