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Self-Management - 360 Degree Feedback Survey Sample #2





Questionnaires Measuring Self:
Survey 1 (4-point scale; Competency Comments)
Survey 2 (4-point scale; Competency Comments)
Survey 3 (5-point scale; Competency Comments)
Survey 4 (5-point scale; radio buttons)
Survey 5 (4-point scale; words)
Survey 6 (4-point scale; words)
Survey 7 (5-point scale; competency comments; N/A)
Survey 8 (3-point scale; Agree/Disagree words; N/A)
Survey 9 (3-point scale; Strength/Development; N/A)
Survey 10 (Comment boxes only)
Survey 11 (Single rating per competency)
Survey 12 (Slide-bar scale)
Survey 13 (4-point scale; numbers; floating anchors)
Survey 14 (4-point scale; N/A)
Self-Assessment Instructions

You have been asked to complete a self-assessment questionnaire form (shown below). You will also receive feedback from others such as your peers, direct reports and manager. Feedback is an important part of our company's leadership development process and this survey 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 questions below, think about your experiences as an employee over the last twelve months and the goals you were asked to achieve. The effectiveness of this development tool is dependent on your honest, forthright and constructive responses so please bear this in mind as you answer each question. Your responses will become part of the assessment process to foster your growth and on-going development.

Competencies Included:
Self Management, Passion To Learn, Establishing Focus/Direction, Analytical, Flexibility, Initiative, Results Oriented, Commitment To Result, Developing Others, Conflict Management, Business Acumen, Entrepreneurship
Sample Result Document:
Sample Results
Partially completed forms can be saved by using the Save/Still Working button at the bottom of the page. You may return at a later time to complete/edit the form. Your saved responses will be shown each time you re-visit the feedback form. When you are certain that you have completed your responses and will be not making any changes, click the Complete button.

Please ensure that your submission is made between . The survey will only be available during these dates.
Edit this Survey
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Self Management

Clear
Strength
Capable
and
Effective
Could
Benefit from
Development
Needs
Significant
Improvement
  1. You set an example for associates during stressful periods by maintaining a positive, can-do attitude.
  1. You use patience and self-control in working with customers and associates.
  1. You analyze interpersonal problems instead of reacting to them.
  1. You step away from a situation to process appropriate response.
  1. You do not allow own emotions to interfere with the performance of others.
What are your suggestions for how you can make improvements
in Self Management?

Passion To Learn

Clear
Strength
Capable
and
Effective
Could
Benefit from
Development
Needs
Significant
Improvement
  1. You exhibit willingness to upgrade skills through additional training and education.
  1. You enhance your value to the company through additional training and development.
  1. You embrace new technology and procedures.
  1. You constantly enhance product knowledge through experimentation and play.
  1. You create an environment that supports personal development and exploration.
What are your suggestions for how you can make improvements
in Passion To Learn?

Establishing Focus/Direction

Clear
Strength
Capable
and
Effective
Could
Benefit from
Development
Needs
Significant
Improvement
  1. You stay focused even when under pressure and stress.
  1. You align the department's goals with the goals of the organization.
  1. You maintain focus when handling several problems or tasks simultaneously.
  1. You set appropriate goals for employees.
  1. You maintain self-control when personally criticized.
What are your suggestions for how you can make improvements
in Establishing Focus/Direction?

Analytical

Clear
Strength
Capable
and
Effective
Could
Benefit from
Development
Needs
Significant
Improvement
  1. I examine patient orders to determine the proper dosage of medicines.
  1. I calculate and interpret financial ratios (such as liquidity ratios, profitability ratios, and leverage ratios) to assess the financial health of the company.
  1. I evaluate evidence objectively, regardless of whether it supports or contradicts current ideas.
  1. You are open minded and receptive to considering opposing evidence.
  1. You are precise in the measurement of variables, leading to more accurate data collection.
What are your suggestions for how you can make improvements
in Analytical?

Flexibility

Clear
Strength
Capable
and
Effective
Could
Benefit from
Development
Needs
Significant
Improvement
  1. I am able to make changes to my leadership style after receiving constructive feedback through the performance review.
  1. I am flexible in my approach to dealing with unpredictable events.
  1. You foster a culture where diverse perspectives are valued allowing the team to adapt more easily to changes and draw on a wider range of ideas and solutions.
  1. I allow for flexibility in setting realistic performance goals.
  1. You identify new opportunities to achieve goals
What are your suggestions for how you can make improvements
in Flexibility?

Initiative

Clear
Strength
Capable
and
Effective
Could
Benefit from
Development
Needs
Significant
Improvement
  1. I address small problems before they become big ones.
  1. I analyze the needs of the situation and act before being told to do so.
  1. You immediately work to complete goals well before your deadline.
  1. I look to start work on new projects without waiting for direction from the manager.
  1. You take corrective action to address performance deficiencies/issues.
What are your suggestions for how you can make improvements
in Initiative?

Results Oriented

Clear
Strength
Capable
and
Effective
Could
Benefit from
Development
Needs
Significant
Improvement
  1. You have a strong result orientation.
  1. You inspire and motivates co-workers to be productive and energetic at work
  1. I am motivated by a strong desire to exceed performance standards.
  1. You stay focused on meeting the needs of customers.
  1. You do not become distracted by non-issues or interruptions.
What are your suggestions for how you can make improvements
in Results Oriented?

Commitment To Result

Clear
Strength
Capable
and
Effective
Could
Benefit from
Development
Needs
Significant
Improvement
  1. You coordinate all department activities into a cohesive team effort.
  1. You convey strong sense of own pride in Company to associates by creating a shared vision around sales and customer service.
  1. You create a sense of urgency among the store team members to complete activities, which drive sales.
  1. You take immediate action toward goals.
  1. You maintain persistence and dedication to achieving results.
What are your suggestions for how you can make improvements
in Commitment To Result?

Developing Others

Clear
Strength
Capable
and
Effective
Could
Benefit from
Development
Needs
Significant
Improvement
  1. You assign tasks and responsibilities to develop skills of others.
  1. You provide constructive feedback to others.
  1. You recognize and celebrates accomplishments of others.
  1. You create opportunities for professional development.
  1. You encourage employees through recognition of positive changes in behavior.
What are your suggestions for how you can make improvements
in Developing Others?

Conflict Management

Clear
Strength
Capable
and
Effective
Could
Benefit from
Development
Needs
Significant
Improvement
  1. I encourage individuals to seek areas of common ground.
  1. I remove misperceptions that may be contributing to the conflict.
  1. I facilitate collaborative processes to reduce conflict.
  1. I ensure that all team members feel respected and heard.
  1. I attentively listen to each person as they share their distinct viewpoints on the matter.
What are your suggestions for how you can make improvements
in Conflict Management?

Business Acumen

Clear
Strength
Capable
and
Effective
Could
Benefit from
Development
Needs
Significant
Improvement
  1. I create robust talent development programs through the identification of key skills gaps and future needs ensuring the company is able to meet its mission and vision.
  1. You provide a high level of business services to customers.
  1. I gather important information from customers to make sure our products are relevant and useful.
  1. You apply the knowledge of work processes to influence the achievement of business goals
  1. You reward risky ideas that may yield significant benefits to the business.
What are your suggestions for how you can make improvements
in Business Acumen?

Entrepreneurship

Clear
Strength
Capable
and
Effective
Could
Benefit from
Development
Needs
Significant
Improvement
  1. You encourage dynamic growth opportunities.
  1. You seek and utilize mentors to help guide your professional development.
  1. You are excellent at managing relationships with stakeholders.
  1. You understand the processes and various stages of business development.
  1. You balance risks and rewards when making decisions.
What are your suggestions for how you can make improvements
in Entrepreneurship?


  1. Strengths


  2. Areas for Development


  3. Please give any final comments or suggestions for [Participant Name Here]'s assessment.