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 actively seek the root cause of a problem.
You are able to solve problems at root cause rather than at symptom level.
You identify and assess all potential responses to a problem.
You solve problems using logic and insight.
You work cooperatively with others to solve problems.
Innovation	Agree	Unsure	Disagree	N/A
I focus the team on important innovations.
You take risks to reach beyond boundaries.
I ensure employees possess the necessary technical competencies to engage in innovation.
I investigate all types of innovations.
You facilitate acceptance of new ideas.
Flexibility	Agree	Unsure	Disagree	N/A
I am flexible in effectively handling changes in production volumes.
You are able to produce a wide range of products/services to meet demands.
I am willing to change ideas or perceptions based on new information.
I adapt the onboarding experience to meet the unique needs of each new employee.
You show a readiness to adapt and optimize.
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 are open minded and curious about learning new skills.
You take initiative for own learning and development.
You embrace new technology and procedures.
Cultural Awareness	Agree	Unsure	Disagree	N/A
You value the opinions of diverse groups and individual.
You understand how implicit biases can affect decisions, communication and productivity.
I function effectively within various cultural contexts.
You foster a diverse workforce free from discrimination and harassment.
You are curious and willing to ask questions about the cultural differences in the workplace.
Establishing Focus/Direction	Agree	Unsure	Disagree	N/A
You set appropriate goals for employees.
You stay focused even when under pressure and stress.
You maintain self-control when personally criticized.
You maintain focus when handling several problems or tasks simultaneously.
You function well under stress, deadlines, and/or significant workloads.
Administrative Skill	Agree	Unsure	Disagree	N/A
You have a high attention to detail.
You are able to develop, justify and present a budget.
You are enthusiastic about taking on challenging projects.
You accurately implement contract provisions.
You have strong technical/computer skills.
Commitment To Result	Agree	Unsure	Disagree	N/A
You create a sense of urgency among the store team members to complete activities, which drive sales.
You take immediate action toward goals.
You encourage commitment in others to obtain results.
You are willing to do whatever it takes-not afraid to have to put in extra effort.
You maintain persistence and dedication to achieving results.
Objectives	Agree	Unsure	Disagree	N/A
You set long-term and short-term goals.
You effectively organize resources and plans
You consistently provide me with timely feedback for improving my performance.
You assure [Company] principles are understood, employed & pursued.
You are able to organize work.
Responsible	Agree	Unsure	Disagree	N/A
You set a good example
You work in a way that makes others want to work with you.
You are responsible for setting the vision of the department.
You set a good example.
You take personal responsibility for results.
Co-worker Development	Agree	Unsure	Disagree	N/A
You set and clearly communicate expectations, performance goals, and measurements to others
You adapt coaching and mentoring approach to meet the style or needs of individuals
You provide ongoing feedback to co-workers on your development progress
You work to identify root causes of performance problems
You take immediate action on poor performance
Strategic Insight	Agree	Unsure	Disagree	N/A
You adjust strategic plans based on insights gathered from different points of view.
You analyze unique issues or problems impacting the Company.
You identify potential problems before they become critical incidents.
You identify root causes of problems.
You allocate proper resources for employee training to meet future needs based on insight into employee skill levels.

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.