Project Management - 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 4 Performance Levels. Click on the level that best describes this individual.

Please ensure that your submission is made between .

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Project Management	Needs Improvement		Fully Proficient		Excels/ Role Model	Not Applicable
You engage stakeholders and team members in open discussions.
You prepare contingency plans to avoid supply chain disruptions.
You develop action items, workplans, timelines, and criteria for projects.
You identify potential risks to completing the project on time.
I add the necessary time buffers to avoid the project getting behind schedule.
If you were to make improvements in Project Management, what are your suggestions for how you can improve this?
Objectives	Needs Improvement		Fully Proficient		Excels/ Role Model	Not Applicable
You work toward achieving established goals and objectives.
You are able to establish realistic goals.
You effectively organize resources and plans
You are able to organize work.
You encourage others to take on greater responsibility.
If you were to make improvements in Objectives, what are your suggestions for how you can improve this?
Self Management	Needs Improvement		Fully Proficient		Excels/ Role Model	Not Applicable
You do not allow own emotions to interfere with the performance of others.
You are aware of personal impact on others and adjusts behavior to create a positive leadership presence.
You step away from a situation to process appropriate response.
You analyze own reactions on the spot to ensure that communication does not appear to be driven by anger.
You deal with conflict by controlling own emotions by listening, being flexible, and sincere in responding.
If you were to make improvements in Self Management, what are your suggestions for how you can improve this?
Feedback	Needs Improvement		Fully Proficient		Excels/ Role Model	Not Applicable
You accept the views of others.
You consider other's opinion and suggestions.
You seek feedback to enhance performance.
You share past experiences with others as learning opportunities.
You look to others for input.
If you were to make improvements in Feedback, what are your suggestions for how you can improve this?
Responsible	Needs Improvement		Fully Proficient		Excels/ Role Model	Not Applicable
You act as a resource without removing individual responsibility.
You hold yourself accountable to goals / objectives
You take personal responsibility for results.
You set a good example.
You complete assigned work tasks.
If you were to make improvements in Responsible, what are your suggestions for how you can improve this?
Teamwork	Needs Improvement		Fully Proficient		Excels/ Role Model	Not Applicable
You apply knowledge of team behavior to help achieve organizational goals and objectives.
I help other team members to research solutions to a problem.
You demonstrate an understanding of other team member's viewpoints.
You make eye contact when listening to colleagues.
You encourage dialog between team members.
If you were to make improvements in Teamwork, what are your suggestions for how you can improve this?
Strategic Insight	Needs Improvement		Fully Proficient		Excels/ Role Model	Not Applicable
You work with others to develop insights into the resources and actions required to produce desired results.
I recognize the needs of customers.
You ommunicate with employees to find out their needs.
You identify root causes of problems.
You create a mission statement describing the purpose for the organization.
If you were to make improvements in Strategic Insight, 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.