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 enhance your value to the company through additional training and development.
You enjoy learning new skills and techniques.
You take initiative for own learning and development.
You are committed to enhancing your own knowledge and skills.
You create an environment that supports personal development and exploration.
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 are open to the suggestions of others.
You actively seek feedback from others.
You consider other's opinion and suggestions.
You accept the views of others.
You seek feedback to enhance performance.
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 conceive, implement and evaluate ideas.
You create a lot of new ideas.
You develop solutions to challenging problems.
You add value to the department/organization.
You are creative and inspirational.
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 start the workday when scheduled.
You avoid making personal phone calls during working hours.
You arrive to meetings on time.
You invoice clients on a timely basis.
You conduct appointments at scheduled start time.
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
I am skilled at quickly diagnosing issues, identifying root causes, and developing and implementing effective solutions in the workplace.
You identify and assess all potential responses to a problem.
You actively seek the root cause of a problem.
You are effective in solving problems.
You are able to solve problems at root cause rather than at symptom level.
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 are clear about goals that need to be achieved.
You avoid creating ambiguity or mixed messages.
You attend to the important details of a job or task.
You are clear about the roles and duties of team members.
You communicate ideas and facts clearly and effectively in writing.
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 effectively manage appropriations, reporting, purchases, expenditures, payrolls, and staff.
You monitor expenses and verify the need for items purchased.
You develop budgets and plans for various programs and initiatives.
You monitor spending.
You develop of the department's annual budget.
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.