Sample Self Assessment Questionnaire
This is a resource provided by the Sustainable Economies Law Center for democratic organizations looking for sample peer review questionnaires. SELC provides these resources as examples for you to take, change, and share! Feel free to make a copy and amend it to meet your organizational needs. Below are instructions on how SELC performs our Peer Performance Review.

Find all of our internal policies by visiting our public policy doc:
https://docs.google.com/document/d/1iTYK2yjK8HcWB-h7aVfY2fJLHWYSRx__Dp7Cki0_dxU/edit

To learn more about SELC, please visit www.theselc.org.

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Periodic Performance Review Process
To provide a space to give and receive constructive feedback on each staff members’ long-term effectiveness and professional development, each core staff member will participate in a bi-annual review process. This consists of a written self-assessment form, a written peer assessment form completed by other staff working within one or more overlapping programs circles (that's this form), and a performance review conversation with at least two other colleagues.
1. Self-Assessment (this form)
Self-assessment provides an opportunity to personally identify areas of growth and areas of challenge, as well as identify goals for the coming six months and professional skills that should be acquired for personal/professional development.
2. Peer Assessment
Peer assessment provides core staff an opportunity to anonymously give feedback to other members of their program circles, ideally acknowledging both effective behavior and areas that might be improved.

Self and Peer Assessment forms and responses are tracked in a folder accessible to all staff.

The Peer Assessment form can be viewed here: https://docs.google.com/a/theselc.org/forms/d/1Q-ey1YtwmzWrYTG5NAD2drgm4BIu45w9RCaTXWfTcG4/viewform

3. Performance Review Conversation
Following completion of the written self-assessment and peer assessment, and following a regular bi-annual schedule to be determined, each staff member will participate in a review conversation with at least two other colleagues that works closely within the same program circles. Using a circle process, all present will read and respond to the self-assessment form and the peer assessment form, followed by general conversation on areas and practices for improvement, refining the roles and goals of the staff person for the coming year, and support needed for continued professional development. At all times, peer reviewers should follow the Guidelines for Giving Good Feedback (below), and reviewee should remain open to receiving feedback from colleagues.
Self Assessment Instructions
Thanks for taking the time to reflect on where you are and where you've been with SELC!

During this assessment, you'll be reflecting and rating yourself on

Personal efficiency and effectiveness - How efficiently have I been fulfilling my responsibilities?

Personal well being - How is this work affecting me personally?

Workplace culture – How well do I collaborate and work with my team?

Learning and development – What future learning goals or development milestones do you want to meet?

Please write your name. *
Your answer
List the Roles and Circles that you are responsible for energizing, and the approximate percentage of your time that you spend on each. *
Make your best guess if you are unsure about exact times.
Your answer
Your efficiency in completing assigned tasks and general time management
Your compliance with organizational policies and practices
such as logging information in various shared docs and apps, participation in meetings, abidance by organizational policies, etc.
Your creativity in completing tasks and devising new ones?
How manageable does your current workload feel?
Where could you use support from other staff?
Your answer
What skills/attriibutes do you bring to the team? What are your best skills/attributes?
Your answer
How effectively do you feel those skills/attributes are being used in your day-to-day responsibilities?
Want to say more about how those skills/attributes are being used in your day-to-day responsibilities?
Your answer
In general, how has your personal effectiveness changed over the past 6 months?
What are some of your personal accomplishments over the past 6 months?
Your answer
What areas of your personal effectiveness would you most like to improve on?
Your answer
Do you generally feel focused in your work?
Do you generally feel fulfilled by your work?
How often do you feel stressed and overwhelmed by your work?
Do you feel supported by colleagues?
How has your personal wellbeing changed over the past 6 months?
What particular areas of your work are you feeling really productive and fulfilled in?
Your answer
What particular areas of your work are you feeling overly-stressed or burdened by?
Your answer
Ability to collaborate with other staff
Ability to collaborate with partner organizations and volunteers
Punctuality and participation in staff meetings (including full staff and circle meetings)
Are there aspects of SELC’s work culture/policies/structure that are particularly exciting or inspiring to you?
Your answer
Are there aspects of SELC’s work culture/policies/structure that are particularly challenging for you?
Your answer
Do you believe you have taken too much or too little time off?
Your answer
What would you like to do more of in the coming year?
Your answer
What would you like to do less of in the coming year?
Your answer
What skills would you like to cultivate in the coming year?
Your answer
What knowledge would you like to cultivate in the coming year?
Your answer
How can SELC best support that development?
Your answer
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