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.



Please complete your response by .

Problem Solving	Agree	Unsure	Disagree	N/A
You find creative ways to get things done with limited resources.
You are able to solve problems at root cause rather than at symptom level.
You identify fresh approaches and shows a willingness to question traditional assumptions.
You are effective in solving problems.
You actively seek the root cause of a problem.
Innovation	Agree	Unsure	Disagree	N/A
You implement best practices within the department.
You develop new products and services.
You find creative ways to get things done with limited resources.
You suggest new ideas at meetings.
You offer constructive improvements to existing systems.
Flexibility	Agree	Unsure	Disagree	N/A
You are effective in incorporating new ideas.
You act decisively in frequently changing and uncertain environment.
You identify new opportunities to achieve goals
You implement changes as a result of having listened to employees
You encourage others to adopt new procedures.
Passion To Learn	Agree	Unsure	Disagree	N/A
You hold self and associates accountable for goal achievement.
You demonstrate through personal behavior the commitment to high standards of performance.
You create an environment that supports personal development and exploration.
You exhibit willingness to upgrade skills through additional training and education.
You take advantage of training opportunities when they arise.
Cultural Awareness	Agree	Unsure	Disagree	N/A
You understand how your own cultural background can impact the way you communicate and interact with others.
You maintain an inclusive work environment that maximizes the talents of others in achieving goals.
You are curious and willing to ask questions about the cultural differences in the workplace.
You understand what customs and etiquette are important for individuals from other cultures.
I seek knowledge and information about other cultures.
Establishing Focus/Direction	Agree	Unsure	Disagree	N/A
You function well under stress, deadlines, and/or significant workloads.
You are excellent at managing time.
You maintain focus when handling several problems or tasks simultaneously.
You set appropriate goals for employees.
You maintain self-control when personally criticized.
Administrative Skill	Agree	Unsure	Disagree	N/A
You complete reports on-time.
You are able to develop, justify and present a budget.
You have strong organizational skills to keep the workspace and department in order
You have a high attention to detail.
You implement and use performance measures.
Commitment To Result	Agree	Unsure	Disagree	N/A
You encourage commitment in others to obtain results.
You maintain persistence and dedication to achieving results.
You are willing to do whatever it takes-not afraid to have to put in extra effort.
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.
Objectives	Agree	Unsure	Disagree	N/A
You assure [Company] principles are understood, employed & pursued.
You organize and schedules events, activities, and resources.
You consistently provide me with timely feedback for improving my performance.
You are able to organize work.
You establish goals and objectives.
Responsible	Agree	Unsure	Disagree	N/A
You are a person others can trust.
You set a good example
You act as a resource without removing individual responsibility.
You work in a way that makes others want to work with you.
You set a good example.
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 work to identify root causes of performance problems
You take immediate action on poor performance
Strategic Insight	Agree	Unsure	Disagree	N/A
You implement long-term solutions to problems.
You create values statements to ensure all employees are working under the same guiding principles.
You analyze unique issues or problems impacting the Company.
I develop a strategic vision for the future.
I inspire employees to adopt the strategic plan.

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.