Passion to Learn - 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 5 Performance Levels. Click on the level that best describes this individual.

Please ensure that your submission is made between .

Passion To Learn	Needs Improvement		Fully Proficient		Excels/ Role Model	Not Applicable
You inspire others to learn new things.
You will participate in training classes even if offered outside of normal working hours.
You demonstrate a willingness to participate in continuing education courses.
You embrace new technology and procedures.
You recognize own areas for development and consciously seek assignments that will provide practice in areas of developmental need.
If you were to make improvements in Passion To Learn, what are your suggestions for how you can improve this?
Feedback	Needs Improvement		Fully Proficient		Excels/ Role Model	Not Applicable
You actively seek feedback from others.
You consider other's opinion and suggestions.
You seek feedback to enhance performance.
You look to others for input.
You share past experiences with others as learning opportunities.
If you were to make improvements in Feedback, what are your suggestions for how you can improve this?
Creativity	Needs Improvement		Fully Proficient		Excels/ Role Model	Not Applicable
You create a lot of new ideas.
You inspire creativity in your team.
You develop solutions to challenging problems.
You conceive, implement and evaluate ideas.
You add value to the department/organization.
If you were to make improvements in Creativity, what are your suggestions for how you can improve this?
Punctuality	Needs Improvement		Fully Proficient		Excels/ Role Model	Not Applicable
You avoid making personal phone calls during working hours.
You maintain an efficient schedule of activities.
You start meetings on time.
You conduct appointments at scheduled start time.
You respond to requests for information in a timely manner.
If you were to make improvements in Punctuality, what are your suggestions for how you can improve this?
Problem Solving	Needs Improvement		Fully Proficient		Excels/ Role Model	Not Applicable
You identify fresh approaches and shows a willingness to question traditional assumptions.
You generate alternative solutions to problems and challenges.
You implement effective solutions to critical problems.
You are effective in solving problems.
You are able to balance the needs of different people in a solution to a problem.
If you were to make improvements in Problem Solving, what are your suggestions for how you can improve this?
Clarity	Needs Improvement		Fully Proficient		Excels/ Role Model	Not Applicable
You communicate ideas and facts clearly and effectively in writing.
You avoid creating ambiguity or mixed messages.
You check details thoroughly.
You clearly explain the vision and goals of the company.
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?
Fiscal Management	Needs Improvement		Fully Proficient		Excels/ Role Model	Not Applicable
You provide budgeting and accounting support to the Company.
You keep excellent records for financial transparency.
You develop budgets and plans for various programs and initiatives.
You develop of the department's annual budget.
You ensure others follow the correct rules and regulations on fiscal matters.
If you were to make improvements in Fiscal Management, what are your suggestions for how you can improve this?

36. Strengths
    
    
    
37. Areas for Development
    
    
    
38. Please give any final comments or suggestions for [Participant Name Here]'s assessment.