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 take initiative for own learning and development.
You create an environment that supports personal development and exploration.
You will participate in training classes even if offered outside of normal working hours.
You recognize own areas for development and consciously seek assignments that will provide practice in areas of developmental need.
You enjoy learning new skills and techniques.
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 accept the views of others.
You are visible and approachable.
You consider other's opinion and suggestions.
You look to others for input.
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 add value to the department/organization.
You inspire creativity in your team.
You develop solutions to challenging problems.
You are creative.
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 avoid making personal phone calls during working hours.
You respond to requests for information in a timely manner.
You arrive to meetings on time.
You conduct appointments at scheduled start time.
You start the workday when scheduled.
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 find creative ways to get things done with limited resources.
You identify and assess all potential responses to a problem.
You are able to solve problems at root cause rather than at symptom level.
You generate alternative solutions to problems and challenges.
You understand the root causes of problems.
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 attend to the important details of a job or task.
You clarify problems and their causes to help employees correct them.
You adjust communication methods to the needs of the audience.
You write clear job descriptions for positions in the organization.
You check details thoroughly.
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 develop of the department's annual budget.
You monitor expenses and verify the need for items purchased.
You ensure others follow the correct rules and regulations on fiscal matters.
You keep excellent records for financial transparency.
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.