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 set long-term and short-term goals.
You work toward achieving established goals and objectives.
You consistently provide me with timely feedback for improving my performance.
You effectively organize resources and plans
You organize and schedules events, activities, and resources.
Achievement	Agree	Unsure	Disagree	N/A
You establish Specific Measurable Achievable Realistic and Timed (SMART) goals.
I work to meet required benchmarks for the position.
You successfully complete the orientation training program.
You inspire others to work with a sense of urgency.
You work at a quick pace to complete a high volume of work.
Establishing Focus/Direction	Agree	Unsure	Disagree	N/A
You maintain self-control when personally criticized.
You function well under stress, deadlines, and/or significant workloads.
You help guide employees with prioritizing tasks.
You make sure that employees understand and identify with the team's mission.
You are excellent at managing time.
Innovation	Agree	Unsure	Disagree	N/A
You take risks to advance important ideas.
You suggest new ideas at meetings.
You build upon the ideas and solutions of others.
You implement best practices within the department.
You create improved methods or solutions for meeting goals and objectives.
Interpersonal Skills	Agree	Unsure	Disagree	N/A
You value the opinions of others.
I am transparent and honest in communications, intentions, and actions.
You attend to both the content and the context of what was being said.
I am honest about making mistakes and willing to fix them.
You come across as credible, knowledgeable and sincere
Responsible	Agree	Unsure	Disagree	N/A
You work in a way that makes others want to work with you.
You are a person others can trust.
You hold yourself accountable to goals / objectives
You set a good example
You take personal responsibility for results.
Coaching	Agree	Unsure	Disagree	N/A
You address employee behavior problems effectively.
You coach employees in how to strengthen knowledge and skills to improve work performance.
You develop the skills and capabilities of others.
You conduct regular performance appraisals and feedback.
You provide clear, motivating, and constructive feedback.
Others	Agree	Unsure	Disagree	N/A
You consistently demonstrate ability and willingness to trust others.
You include others in the decision making processes.
You treat others with respect and dignity.
You work across boundaries within the organization.
You are able to see issues from others' perspectives.
Cultural Awareness	Agree	Unsure	Disagree	N/A
I seek knowledge and information about other cultures.
I seek clarification to avoid misunderstandings.
You are curious and willing to ask questions about the cultural differences in the workplace.
You understand how implicit biases can affect decisions, communication and productivity.
You engage with individuals that have different cultural backgrounds.
Global Perspective	Agree	Unsure	Disagree	N/A
You attend training seminars and conferences to increase skills in working with others globally.
You understand and appreciate the perspectives offered by others with different cultural backgrounds.
You understand global systems such as the global economy.
You demonstrate working knowledge of global transactions.
You can effectively deliver presentations to international clients.

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.