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 consistently provide me with timely feedback for improving my performance.
You are able to establish realistic goals.
You assure [Company] principles are understood, employed & pursued.
You organize and schedules events, activities, and resources.
Achievement	Agree	Unsure	Disagree	N/A
You are flexible in adjusting priorities to meet the demands of changing situations.
You demonstrate a sense of urgency to quickly and accurately solve problems and issues.
You schedule time for self and others to optimize high priority and long term actions. Monitors progress towards business goals.
You inspire others to work with a sense of urgency.
You use established goals and performance measures to keep track of performance.
Establishing Focus/Direction	Agree	Unsure	Disagree	N/A
You are excellent at managing time.
You maintain self-control when personally criticized.
You stay focused even when under pressure and stress.
You function well under stress, deadlines, and/or significant workloads.
You set appropriate goals for employees.
Innovation	Agree	Unsure	Disagree	N/A
You solve problems with insight and understanding.
You develop new products and services.
You search for opportunities and innovative ways to improve the organization.
You suggest new ideas at meetings.
You foster a creative and innovative work environment.
Interpersonal Skills	Agree	Unsure	Disagree	N/A
You apply appropriate communication techniques to the situation.
You effectively manage conflicts by dealing with them directly and immediately
You are able to work with individuals at all levels of the company.
You strive for win/win solutions
You successfully resolve conflicts and grievances to a win-win solution.
Responsible	Agree	Unsure	Disagree	N/A
You are responsible for setting the vision of the department.
You hold yourself accountable to goals / objectives
You take personal responsibility for results.
You are a person others can trust.
You work in a way that makes others want to work with you.
Coaching	Agree	Unsure	Disagree	N/A
You conduct regular performance appraisals and feedback.
You help employees to understand responsibilities, authority, and expectations.
You develop the skills and capabilities of others.
You help employees to maintain high personal standards.
You coach employees in how to strengthen knowledge and skills to improve work performance.
Others	Agree	Unsure	Disagree	N/A
You support the efforts of other employees in implementing solutions to problems.
You constructively receive criticism and suggestions from others.
You form working relationships with employees from other departments.
You work effectively with people from other departments.
You include others in the decision making processes.
Cultural Awareness	Agree	Unsure	Disagree	N/A
I view diversity as a strength, not as an issue.
I am effective in working with individuals with a variety of cultural backgrounds.
You understand the impact that your culture may have on interactions between individuals.
You recognize and value individual and cultural differences.
You value the opinions of diverse groups and individual.
Global Perspective	Agree	Unsure	Disagree	N/A
You apply knowledge of overseas markets.
You accept setbacks and challenges in foreign markets as improvement opportunities
You set the example for team on importance of cultural awareness.
You consider customers point of view when making decisions.
You analyze global issues/problems that are having a large impact on the Company.

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.