Passion to Learn - 360 Degree Feedback Survey Sample #7

360 Feedback Survey

Self-Assessment Form Instructions

[Participant Name Here] 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 .

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Passion To Learn	Needs Improvement		Fully Proficient		Excels/ Role Model	Not Applicable
You enjoy learning new skills and techniques.
You embrace new technology and procedures.
You demonstrate through personal behavior the commitment to high standards of performance.
You demonstrate a willingness to participate in continuing education courses.
You are open minded and curious about learning new skills.
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 are easy to approach with ideas and opinions.
You accept the views of others.
You are visible and approachable.
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 inspire creativity in your team.
You create a lot of new ideas.
You conceive, implement and evaluate ideas.
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 invoice clients on a timely basis.
You start the workday when scheduled.
You conduct appointments at scheduled start time.
You maintain an efficient schedule of activities.
You start meetings on 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 implement solutions to solve the problem.
You are able to solve problems at root cause rather than at symptom level.
You are able to isolate the main problem.
I use creative thinking to develop new solutions to problems.
I decide which alternative solutions would have the greatest chance of success.
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 use appropriate grammar and tense in communications.
You make sure goals and objectives are clearly and thoroughly explained and understood.
You clearly explains responsibilities to individuals.
You make sure employees understand why they were given certain assignments.
You are clear about goals that need to be achieved.
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 develop budgets and plans for various programs and initiatives.
You keep excellent records for financial transparency.
You effectively manage appropriations, reporting, purchases, expenditures, payrolls, and staff.
You monitor spending.
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.