Problem Solving - 360 Degree Feedback Survey Sample #8

Self-Assessment Instructions

You have been selected to complete a self-assessment questionnaire as part of a 360-degree feedback assessment. Your feedback is an important part of 's leadership development process. 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.

Respond to the assessment form based on your work experiences during the previous 12 months. Your responses will be merged with other people's feedback and presented to you in your on-going development. Comments from others will be shared anonymously, as written.

Method of use: As part of the review process, managers will receive feedback from peers and staff. It is recognized that not all participants will be able to assess an individual's performance in all areas. The feedback received will be utilized as input to the manager's performance and on-going development plan.

You may sign out at any time by pressing the Save button at the end of the form and then closing your browser. You may return later to pick up where you left off. When you are done, press the Complete button.



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Problem Solving	Agree	Unsure	Disagree	N/A
You are a good problem solver and decision maker.
I pinpoint the origins of the issue to tackle the root causes and solve the problem at its source.
You react to unforeseen consequences of implemented solutions to problems.
You are effective in solving difficult problems.
You ask the "right" questions to size up or evaluate situations.
Innovation	Agree	Unsure	Disagree	N/A
You challenge assumptions about the way things work.
I participate in cross-functional innovation teams.
I establish and monitors key performance indicators (KPIs) for innovation.
You set company-wide innovation performance targets and goals.
Supports innovation at all levels of the organization.
Flexibility	Agree	Unsure	Disagree	N/A
You encourage others to adopt new procedures.
You are open to change and new ways of doing things.
You work effectively during periods of change.
You recognize and quickly adapt to shifts in the environment, market, or industry.
I support a culture that values flexibility, continuous improvement and innovation.
Passion To Learn	Agree	Unsure	Disagree	N/A
You create an environment that supports personal development and exploration.
You inspire others to learn new things.
You recognize own areas for development and consciously seek assignments that will provide practice in areas of developmental need.
You enhance your value to the company through additional training and development.
You exhibit willingness to upgrade skills through additional training and education.
Cultural Awareness	Agree	Unsure	Disagree	N/A
You avoid referring to stereotypes about others from different cultures.
You understand the impact that your culture may have on interactions between individuals.
I help other employees to become more culturally sensitive.
I seek clarification to avoid misunderstandings.
I view diversity as a strength, not as an issue.
Establishing Focus/Direction	Agree	Unsure	Disagree	N/A
You maintain focus when handling several problems or tasks simultaneously.
You align the department's goals with the goals of the organization.
You set appropriate goals for employees.
You stay focused even when under pressure and stress.
You help guide employees with prioritizing tasks.
Administrative Skill	Agree	Unsure	Disagree	N/A
You take responsibility for decisions.
You implement and use performance measures.
You complete reports on-time.
You have strong technical/computer skills.
You are enthusiastic about taking on challenging projects.
Commitment To Result	Agree	Unsure	Disagree	N/A
You are committed to the team.
You coordinate all department activities into a cohesive team effort.
You convey strong sense of own pride in Company to associates by creating a shared vision around sales and customer service.
You maintain persistence and dedication to achieving results.
You create a sense of urgency among the store team members to complete activities, which drive sales.
Objectives	Agree	Unsure	Disagree	N/A
You assure [Company] principles are understood, employed & pursued.
You establish goals and objectives.
You set long-term and short-term goals.
You work toward achieving established goals and objectives.
You encourage others to take on greater responsibility.
Responsible	Agree	Unsure	Disagree	N/A
You set a good example
You are a person others can trust.
You set high personal standards of performance.
You set a good example.
You act as a resource without removing individual responsibility.
Co-worker Development	Agree	Unsure	Disagree	N/A
You provide ongoing feedback to co-workers on your development progress
You set and clearly communicate expectations, performance goals, and measurements to others
You give others development opportunities through project assignments and increased job responsibilities
You take immediate action on poor performance
You adapt coaching and mentoring approach to meet the style or needs of individuals
Strategic Insight	Agree	Unsure	Disagree	N/A
You analyze unique issues or problems impacting the Company.
I attend industry conferences to gain further insight into how other companies deal with similar issues.
You develop a plan and strategy for each functional area within the mission statement.
You maintain knowledge of current trends in the industry.
I create a vision for the organization based on insights gathered from other companies in the industry.

61. Overall, please rate the effectiveness of [Participant Name Here].
    

    5- Very Effective 4- Effective 3- Neither 2- Ineffective 1- Very Ineffective

    
    
62. Strengths
    
    
    
63. Areas for Development
    
    
    
64. Please give any final comments or suggestions for [Participant Name Here]'s assessment.