360 Assessment
High Performance Impact
Instructions
Please be in a quiet place, where you can focus and be fully present while answering the questions within this form. Be honest and answer from your heart, DO NOT overthink the questions. Remember, your genuine responses will help the individual being assessed, as well as your organization, the entire team and the people you serve. NOTE: YOUR RESPONSES ARE STRICTLY CONFIDENTIAL.
Name
*
First Name
Last Name
Email
*
example@example.com
Name of your organization:
*
General
Please indicate your position in the organization relative to this person being assessed
*
Board member
Direct report (you report directly to this person being assessed)
Skip level (you do not directly report to this person being assessed)
Self (you are the person being assessed)
In as few words as possible, what do you believe this persons zone of genius is? (this is their unique ability that includes their talents, strengths and characteristics that define who they are, what they're naturally good at and seems easy for them to do; this is often an area you count on this person for because you know they're gifted in this area)
What does this person do best?
What could this person improve?
What advice would you give this person?
How would you rate this person's overall performance?
*
1 = Poor
2 = Needs improvement
3 = Meets expectations
4 = Exceeds requirements
5 = Exceptional work
Please elaborate on why you rated this person's overall performance the way you did?
*
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Next
SELF-LEADERSHIP
The remaining questions all have the same multiple choice options.
Integrity
Self Leadership
This person does what they say they're going to do...
*
1 = Does not describe this person at all
2 = Does not describe this person much
3 = Does not describe this person very well
4 = Describes this person somewhat
5 = Describes this person well
6 = Describes this person very well
7 = Describes this person exactly
N/A - Not applicable or N/O - Not observed
This person holds the highest standard in the organization...
*
1 = Does not describe this person at all
2 = Does not describe this person much
3 = Does not describe this person very well
4 = Describes this person somewhat
5 = Describes this person well
6 = Describes this person very well
7 = Describes this person exactly
N/A - Not applicable or N/O - Not observed
This person is respectful of others...
*
1 = Does not describe this person at all
2 = Does not describe this person much
3 = Does not describe this person very well
4 = Describes this person somewhat
5 = Describes this person well
6 = Describes this person very well
7 = Describes this person exactly
N/A - Not applicable or N/O - Not observed
This person holds everyone to the same standard, there are no favorites...
*
1 = Does not describe this person at all
2 = Does not describe this person much
3 = Does not describe this person very well
4 = Describes this person somewhat
5 = Describes this person well
6 = Describes this person very well
7 = Describes this person exactly
N/A - Not applicable or N/O - Not observed
Self Leadership: Integrity - Score
Ownership
Self Leadership
This person demonstrates poise and control under stressful situations...
*
1 = Does not describe this person at all
2 = Does not describe this person much
3 = Does not describe this person very well
4 = Describes this person somewhat
5 = Describes this person well
6 = Describes this person very well
7 = Describes this person exactly
N/A - Not applicable or N/O - Not observed
This person effectively manages their emotions...
*
1 = Does not describe this person at all
2 = Does not describe this person much
3 = Does not describe this person very well
4 = Describes this person somewhat
5 = Describes this person well
6 = Describes this person very well
7 = Describes this person exactly
N/A - Not applicable or N/O - Not observed
When this person makes a mistake they take full responsibility
*
1 = Does not describe this person at all
2 = Does not describe this person much
3 = Does not describe this person very well
4 = Describes this person somewhat
5 = Describes this person well
6 = Describes this person very well
7 = Describes this person exactly
N/A - Not applicable or N/O - Not observed
This person has a high level of self awareness and a desire to always improve...
*
1 = Does not describe this person at all
2 = Does not describe this person much
3 = Does not describe this person very well
4 = Describes this person somewhat
5 = Describes this person well
6 = Describes this person very well
7 = Describes this person exactly
N/A - Not applicable or N/O - Not observed
Self Leadership: Ownership - Score
Section Summary
Self Leadership
What advice would you give this person to improve their performance in their leadership over themselves (Self Leadership) ?
Self Leadership - Cumulative Score
RELATIONAL-LEADERSHIP
Communication
Relational Leadership
This person has very good communication skills...
*
1 = Does not describe this person at all
2 = Does not describe this person much
3 = Does not describe this person very well
4 = Describes this person somewhat
5 = Describes this person well
6 = Describes this person very well
7 = Describes this person exactly
N/A - Not applicable or N/O - Not observed
This person communicates clearly so ideas, and projects, are easily understood...
*
1 = Does not describe this person at all
2 = Does not describe this person much
3 = Does not describe this person very well
4 = Describes this person somewhat
5 = Describes this person well
6 = Describes this person very well
7 = Describes this person exactly
N/A - Not applicable or N/O - Not observed
This person always communicates the truth with tact and compassion, even though it may hurt sometimes...
*
1 = Does not describe this person at all
2 = Does not describe this person much
3 = Does not describe this person very well
4 = Describes this person somewhat
5 = Describes this person well
6 = Describes this person very well
7 = Describes this person exactly
N/A - Not applicable or N/O - Not observed
This person listens to what their team has to say...
*
1 = Does not describe this person at all
2 = Does not describe this person much
3 = Does not describe this person very well
4 = Describes this person somewhat
5 = Describes this person well
6 = Describes this person very well
7 = Describes this person exactly
N/A - Not applicable or N/O - Not observed
Relational Leadership: Communication - Score
Influence
Relational Leadership
This person has high influence with others in the organization...
*
1 = Does not describe this person at all
2 = Does not describe this person much
3 = Does not describe this person very well
4 = Describes this person somewhat
5 = Describes this person well
6 = Describes this person very well
7 = Describes this person exactly
N/A - Not applicable or N/O - Not observed
This person trust others to do their work and do it well...
*
1 = Does not describe this person at all
2 = Does not describe this person much
3 = Does not describe this person very well
4 = Describes this person somewhat
5 = Describes this person well
6 = Describes this person very well
7 = Describes this person exactly
N/A - Not applicable or N/O - Not observed
This person is trusted by others because they’re authentic and dependable…
*
1 = Does not describe this person at all
2 = Does not describe this person much
3 = Does not describe this person very well
4 = Describes this person somewhat
5 = Describes this person well
6 = Describes this person very well
7 = Describes this person exactly
N/A - Not applicable or N/O - Not observed
This person does not make commitments lightly…
*
1 = Does not describe this person at all
2 = Does not describe this person much
3 = Does not describe this person very well
4 = Describes this person somewhat
5 = Describes this person well
6 = Describes this person very well
7 = Describes this person exactly
N/A - Not applicable or N/O - Not observed
This person connects with others in the organization on a personal level…
*
1 = Does not describe this person at all
2 = Does not describe this person much
3 = Does not describe this person very well
4 = Describes this person somewhat
5 = Describes this person well
6 = Describes this person very well
7 = Describes this person exactly
N/A - Not applicable or N/O - Not observed
This person has the respect of others in the organization…
*
1 = Does not describe this person at all
2 = Does not describe this person much
3 = Does not describe this person very well
4 = Describes this person somewhat
5 = Describes this person well
6 = Describes this person very well
7 = Describes this person exactly
N/A - Not applicable or N/O - Not observed
Relational Leadership: Influence - Score
Team Focused
Relational Leadership
This person takes the time to build meaningful relationships with others...
*
1 = Does not describe this person at all
2 = Does not describe this person much
3 = Does not describe this person very well
4 = Describes this person somewhat
5 = Describes this person well
6 = Describes this person very well
7 = Describes this person exactly
N/A - Not applicable or N/O - Not observed
This person fosters trust with others...
*
1 = Does not describe this person at all
2 = Does not describe this person much
3 = Does not describe this person very well
4 = Describes this person somewhat
5 = Describes this person well
6 = Describes this person very well
7 = Describes this person exactly
N/A - Not applicable or N/O - Not observed
This person adds value (knowledge, resources) to others when appropriate...
*
1 = Does not describe this person at all
2 = Does not describe this person much
3 = Does not describe this person very well
4 = Describes this person somewhat
5 = Describes this person well
6 = Describes this person very well
7 = Describes this person exactly
N/A - Not applicable or N/O - Not observed
This person creates a strong team environment...
*
1 = Does not describe this person at all
2 = Does not describe this person much
3 = Does not describe this person very well
4 = Describes this person somewhat
5 = Describes this person well
6 = Describes this person very well
7 = Describes this person exactly
N/A - Not applicable or N/O - Not observed
Relational Leadership: Team Focus - Score
Customer Focused
Relational Leadership
This person has created initiatives to better understand their customer...
*
1 = Does not describe this person at all
2 = Does not describe this person much
3 = Does not describe this person very well
4 = Describes this person somewhat
5 = Describes this person well
6 = Describes this person very well
7 = Describes this person exactly
N/A - Not applicable or N/O - Not observed
It is important to this person to improve the customer experience...
*
1 = Does not describe this person at all
2 = Does not describe this person much
3 = Does not describe this person very well
4 = Describes this person somewhat
5 = Describes this person well
6 = Describes this person very well
7 = Describes this person exactly
N/A - Not applicable or N/O - Not observed
It is important to this person to improve customer results...
*
1 = Does not describe this person at all
2 = Does not describe this person much
3 = Does not describe this person very well
4 = Describes this person somewhat
5 = Describes this person well
6 = Describes this person very well
7 = Describes this person exactly
N/A - Not applicable or N/O - Not observed
Relational Leadership: Customer Focus - Score
Section Summary
Relational Leadership
What advice would you give this person to improve their performance in their leadership with others (Relational Leadership) ?
Relational Leadership: Cumulative Score
Back
Next
WORK "IN" THE ORGANIZATION
Team Efficiency
Working IN The Organization
This person sets clear goals and objectives to drive performance...
*
1 = Does not describe this person at all
2 = Does not describe this person much
3 = Does not describe this person very well
4 = Describes this person somewhat
5 = Describes this person well
6 = Describes this person very well
7 = Describes this person exactly
N/A - Not applicable or N/O - Not observed
This person provides challenging projects in alignment with the goals and objectives…
*
1 = Does not describe this person at all
2 = Does not describe this person much
3 = Does not describe this person very well
4 = Describes this person somewhat
5 = Describes this person well
6 = Describes this person very well
7 = Describes this person exactly
N/A - Not applicable or N/O - Not observed
This person equips team members with the proper resources to achieve goals and objectives…
*
1 = Does not describe this person at all
2 = Does not describe this person much
3 = Does not describe this person very well
4 = Describes this person somewhat
5 = Describes this person well
6 = Describes this person very well
7 = Describes this person exactly
N/A - Not applicable or N/O - Not observed
This person consistently uses KPIs to drive performance…
*
1 = Does not describe this person at all
2 = Does not describe this person much
3 = Does not describe this person very well
4 = Describes this person somewhat
5 = Describes this person well
6 = Describes this person very well
7 = Describes this person exactly
N/A - Not applicable or N/O - Not observed
This person consistently runs weekly meetings…
*
1 = Does not describe this person at all
2 = Does not describe this person much
3 = Does not describe this person very well
4 = Describes this person somewhat
5 = Describes this person well
6 = Describes this person very well
7 = Describes this person exactly
N/A - Not applicable or N/O - Not observed
Work IN The Organization: Team Efficiency - Score
Personal Efficiency
Working IN The Organization
This person effectively manages priorities…
*
1 = Does not describe this person at all
2 = Does not describe this person much
3 = Does not describe this person very well
4 = Describes this person somewhat
5 = Describes this person well
6 = Describes this person very well
7 = Describes this person exactly
N/A - Not applicable or N/O - Not observed
This person is very efficient with managing their time to get things done…
*
1 = Does not describe this person at all
2 = Does not describe this person much
3 = Does not describe this person very well
4 = Describes this person somewhat
5 = Describes this person well
6 = Describes this person very well
7 = Describes this person exactly
N/A - Not applicable or N/O - Not observed
This person is very effective at delegating appropriate tasks…
*
1 = Does not describe this person at all
2 = Does not describe this person much
3 = Does not describe this person very well
4 = Describes this person somewhat
5 = Describes this person well
6 = Describes this person very well
7 = Describes this person exactly
N/A - Not applicable or N/O - Not observed
This person conducts regular weekly meetings with direct reports…
*
1 = Does not describe this person at all
2 = Does not describe this person much
3 = Does not describe this person very well
4 = Describes this person somewhat
5 = Describes this person well
6 = Describes this person very well
7 = Describes this person exactly
N/A - Not applicable or N/O - Not observed
This person regularly sticks to proven processes and systems…
*
1 = Does not describe this person at all
2 = Does not describe this person much
3 = Does not describe this person very well
4 = Describes this person somewhat
5 = Describes this person well
6 = Describes this person very well
7 = Describes this person exactly
N/A - Not applicable or N/O - Not observed
Work IN The Organization: Personal Efficiency - Score
Personal Results
Working IN The Organization
This person produces high quality work…
*
1 = Does not describe this person at all
2 = Does not describe this person much
3 = Does not describe this person very well
4 = Describes this person somewhat
5 = Describes this person well
6 = Describes this person very well
7 = Describes this person exactly
N/A - Not applicable or N/O - Not observed
This person produces reliable high quality results…
*
1 = Does not describe this person at all
2 = Does not describe this person much
3 = Does not describe this person very well
4 = Describes this person somewhat
5 = Describes this person well
6 = Describes this person very well
7 = Describes this person exactly
N/A - Not applicable or N/O - Not observed
This person produces results in alignment with the goals and objectives of the organization…
*
1 = Does not describe this person at all
2 = Does not describe this person much
3 = Does not describe this person very well
4 = Describes this person somewhat
5 = Describes this person well
6 = Describes this person very well
7 = Describes this person exactly
N/A - Not applicable or N/O - Not observed
This person focuses the majority of their efforts within their strength zone…
*
1 = Does not describe this person at all
2 = Does not describe this person much
3 = Does not describe this person very well
4 = Describes this person somewhat
5 = Describes this person well
6 = Describes this person very well
7 = Describes this person exactly
N/A - Not applicable or N/O - Not observed
Work IN The Organization: Personal Results - Score
Personal Attitude
Working IN The Organization
This person has an infectious positive attitude…
*
1 = Does not describe this person at all
2 = Does not describe this person much
3 = Does not describe this person very well
4 = Describes this person somewhat
5 = Describes this person well
6 = Describes this person very well
7 = Describes this person exactly
N/A - Not applicable or N/O - Not observed
This person has the passion to make a difference…
*
1 = Does not describe this person at all
2 = Does not describe this person much
3 = Does not describe this person very well
4 = Describes this person somewhat
5 = Describes this person well
6 = Describes this person very well
7 = Describes this person exactly
N/A - Not applicable or N/O - Not observed
This person has the ambition and desire to make a difference…
*
1 = Does not describe this person at all
2 = Does not describe this person much
3 = Does not describe this person very well
4 = Describes this person somewhat
5 = Describes this person well
6 = Describes this person very well
7 = Describes this person exactly
N/A - Not applicable or N/O - Not observed
This person has the capability to make a positive difference…
*
1 = Does not describe this person at all
2 = Does not describe this person much
3 = Does not describe this person very well
4 = Describes this person somewhat
5 = Describes this person well
6 = Describes this person very well
7 = Describes this person exactly
N/A - Not applicable or N/O - Not observed
Work IN The Organization: Personal Attitude - Score
Section Summary
Working IN The Organization
What advice would you give this person to improve their performance with the work they do IN The Organization?
Work IN The Organization: Cumulative Score
WORK "ON" THE ORGANIZATION
Team Accountability
Working ON The Organization
This person holds people accountable for their committed projects and work…
*
1 = Does not describe this person at all
2 = Does not describe this person much
3 = Does not describe this person very well
4 = Describes this person somewhat
5 = Describes this person well
6 = Describes this person very well
7 = Describes this person exactly
N/A - Not applicable or N/O - Not observed
This person holds people accountable to the organization's values and expectations…
*
1 = Does not describe this person at all
2 = Does not describe this person much
3 = Does not describe this person very well
4 = Describes this person somewhat
5 = Describes this person well
6 = Describes this person very well
7 = Describes this person exactly
N/A - Not applicable or N/O - Not observed
This person confronts poor performance in others with corrective feedback…
*
1 = Does not describe this person at all
2 = Does not describe this person much
3 = Does not describe this person very well
4 = Describes this person somewhat
5 = Describes this person well
6 = Describes this person very well
7 = Describes this person exactly
N/A - Not applicable or N/O - Not observed
This person provides team members full autonomy over projects without micromanaging…
*
1 = Does not describe this person at all
2 = Does not describe this person much
3 = Does not describe this person very well
4 = Describes this person somewhat
5 = Describes this person well
6 = Describes this person very well
7 = Describes this person exactly
N/A - Not applicable or N/O - Not observed
Work ON The Organization: Team Accountability - Score
Inspiration
Working ON The Organization
This person effectively develops others…
*
1 = Does not describe this person at all
2 = Does not describe this person much
3 = Does not describe this person very well
4 = Describes this person somewhat
5 = Describes this person well
6 = Describes this person very well
7 = Describes this person exactly
N/A - Not applicable or N/O - Not observed
This person consistently develops others…
*
1 = Does not describe this person at all
2 = Does not describe this person much
3 = Does not describe this person very well
4 = Describes this person somewhat
5 = Describes this person well
6 = Describes this person very well
7 = Describes this person exactly
N/A - Not applicable or N/O - Not observed
This person empowers others to maximize their performance in their respective roles…
*
1 = Does not describe this person at all
2 = Does not describe this person much
3 = Does not describe this person very well
4 = Describes this person somewhat
5 = Describes this person well
6 = Describes this person very well
7 = Describes this person exactly
N/A - Not applicable or N/O - Not observed
This person ensures all team members are informed with major product/service results…
*
1 = Does not describe this person at all
2 = Does not describe this person much
3 = Does not describe this person very well
4 = Describes this person somewhat
5 = Describes this person well
6 = Describes this person very well
7 = Describes this person exactly
N/A - Not applicable or N/O - Not observed
Work ON The Organization: Inspiration - Score
Strategy
Working ON The Organization
This person regularly communicates the long-term vision of the organization…
*
1 = Does not describe this person at all
2 = Does not describe this person much
3 = Does not describe this person very well
4 = Describes this person somewhat
5 = Describes this person well
6 = Describes this person very well
7 = Describes this person exactly
N/A - Not applicable or N/O - Not observed
This person clearly outlines performance goals and objectives…
*
1 = Does not describe this person at all
2 = Does not describe this person much
3 = Does not describe this person very well
4 = Describes this person somewhat
5 = Describes this person well
6 = Describes this person very well
7 = Describes this person exactly
N/A - Not applicable or N/O - Not observed
This person has a clear strategic plan to achieve the goals and objectives of the organization…
*
1 = Does not describe this person at all
2 = Does not describe this person much
3 = Does not describe this person very well
4 = Describes this person somewhat
5 = Describes this person well
6 = Describes this person very well
7 = Describes this person exactly
N/A - Not applicable or N/O - Not observed
Work ON The Organization: Strategy - Score
Innovation
Working ON The Organization
This person is always looking for ways to improve organizational performance…
*
1 = Does not describe this person at all
2 = Does not describe this person much
3 = Does not describe this person very well
4 = Describes this person somewhat
5 = Describes this person well
6 = Describes this person very well
7 = Describes this person exactly
N/A - Not applicable or N/O - Not observed
This person is often trying to improve current services and products…
*
1 = Does not describe this person at all
2 = Does not describe this person much
3 = Does not describe this person very well
4 = Describes this person somewhat
5 = Describes this person well
6 = Describes this person very well
7 = Describes this person exactly
N/A - Not applicable or N/O - Not observed
This person often thinks about long-term growth opportunities…
*
1 = Does not describe this person at all
2 = Does not describe this person much
3 = Does not describe this person very well
4 = Describes this person somewhat
5 = Describes this person well
6 = Describes this person very well
7 = Describes this person exactly
N/A - Not applicable or N/O - Not observed
This person is often bringing up new creative ideas and solutions…
*
1 = Does not describe this person at all
2 = Does not describe this person much
3 = Does not describe this person very well
4 = Describes this person somewhat
5 = Describes this person well
6 = Describes this person very well
7 = Describes this person exactly
N/A - Not applicable or N/O - Not observed
Work ON The Organization: Innovation - Score
Section Summary
Working ON The Organization
What advice would you give this person to improve their performance with the work they do ON The Organization?
Work ON The Organization: Cumulative Total
360 ASSESSMENT: Final Score
Submit
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