Technical Skills - 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 .

Technical	Needs Improvement		Fully Proficient		Excels/ Role Model	Not Applicable
You know how to produce high quality products/work.
You seek information from others as needed.
You willingly share your technical expertise; sought out as resource by others
You use expertise to identify issues and think through creative solutions to get a problem solved or objective accomplished.
You willingly share information and expertise; sought out as resource by others
If you were to make improvements in Technical, what are your suggestions for how you can improve this?
Self Management	Needs Improvement		Fully Proficient		Excels/ Role Model	Not Applicable
You consciously control own negative emotions in order to keep team morale up.
You are aware of personal impact on others and adjusts behavior to create a positive leadership presence.
You set an example for associates during stressful periods by maintaining a positive, can-do attitude.
You step away from a situation to process appropriate response.
You do not allow own emotions to interfere with the performance of others.
If you were to make improvements in Self Management, what are your suggestions for how you can improve this?
Managing Risk	Needs Improvement		Fully Proficient		Excels/ Role Model	Not Applicable
You create a risk management strategy for the department.
You seek to increase safety in the workplace.
You are concerned about process safety management.
You perform regular risk analyses to minimize adverse outcomes.
You improve process safety where possible.
If you were to make improvements in Managing Risk, what are your suggestions for how you can improve this?
Client Focus	Needs Improvement		Fully Proficient		Excels/ Role Model	Not Applicable
You satisfy client needs.
You are pro-active in dealing with clients and addressing your needs.
You obtain feedback to ensure client needs are being met.
You ensure client commitments and requirements are met or exceeded
You maintain strong relationships with clients.
If you were to make improvements in Client Focus, what are your suggestions for how you can improve this?
Recognition	Needs Improvement		Fully Proficient		Excels/ Role Model	Not Applicable
You are sincerely interested in the suggestions of co-workers
You reinforce and reward employees for accomplishing necessary goals.
You let employees know when they have done well
You readily share credit and gives others opportunity for visibility.
You recognize individuals for a specific outstanding achievement.
If you were to make improvements in Recognition, what are your suggestions for how you can improve this?
Company	Needs Improvement		Fully Proficient		Excels/ Role Model	Not Applicable
You express loyalty and dedication to [Company] in interactions with others.
You understand how decisions impact other business units beyond your immediate department of work group.
You follow existing procedures and processes.
You understand the use of [Company] products and services.
You impress upon others the important aspects of [Company].
If you were to make improvements in Company, what are your suggestions for how you can improve this?
Planning	Needs Improvement		Fully Proficient		Excels/ Role Model	Not Applicable
You are able to look ahead (beyond the present) when addressing the work/needs of the department.
You are able to identify the needs of the department before a major change.
You delegate role to team members to accomplish goals.
You anticipate potential challenges, develops plan to overcome them and then carries out the plan.
You work in an organized manner
If you were to make improvements in Planning, 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.