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 create an environment that supports personal development and exploration.
You enhance your value to the company through additional training and development.
You are open to feedback from others.
You embrace new technology and procedures.
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 visible and approachable.
You look to others for input.
You share past experiences with others as learning opportunities.
You are open to the suggestions of others.
You ask others for their ideas and opinions.
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 develop solutions to challenging problems.
You create a lot of new ideas.
You conceive, implement and evaluate ideas.
You inspire creativity in your team.
You are creative.
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 meetings on time.
You conduct appointments at scheduled start time.
You arrive to meetings on time.
You start the workday when scheduled.
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 make judgments based upon relevant information.
You find creative ways to get things done with limited resources.
You solve problems using logic and insight.
You are effective in solving problems.
You are a good problem solver and decision maker
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 clarify problems and your causes to help employees correct them.
You clearly define work objectives for employees.
You write clear job descriptions for positions in the organization.
You clearly explains responsibilities to individuals.
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 are effective in using company's resources.
You monitor spending.
You keep excellent records for financial transparency.
You monitor expenses and verify the need for items purchased.
You provide budgeting and accounting support to the Company.
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.