Unlock hundreds more features
Save your Form to the Dashboard
View and Export Results
Use AI to Create Forms and Analyse Results

Sign UpLogin With Facebook
Sign UpLogin With Google

Self Assessment Survey Form Template

Enhance Personal and Organizational Growth with Self Assessments

Feeling disconnected from your personal or professional growth? This self-assessment survey form template is designed for both individuals and organizations seeking to gather valuable insights. You can identify strengths and areas for improvement, encourage open communication, and foster a culture of continuous development, all while ensuring compliance with accessibility standards. Use the live template to start your journey of self-discovery and growth.

What is your age?
Under 18
18-24
25-34
35-44
45-54
55-64
65+
What is your gender?
Woman
Man
Non-binary
Prefer to self-describe
Prefer not to say
What is your current primary focus?
Working full-time
Working part-time
Self-employed
Studying
Job-seeking
Caregiving
Retired
Prefer not to say
Other
Please Specify:
Overall, how satisfied are you with your current well-being?
Very dissatisfied
Dissatisfied
Neutral
Satisfied
Very satisfied
Over the past two weeks, how often did you wake up feeling rested?
Very rarely
Rarely
Sometimes
Often
Very often
How would you rate your stress management right now?
Poor
Below average
Average
Good
Exceptional
How often do you plan your day or tasks in advance?
Very rarely
Rarely
Sometimes
Often
Very often
When distractions arise, how easy is it for you to refocus?
Very difficult
Difficult
Neutral
Easy
Very easy
On average, how much daily screen time do you spend on non-essential activities?
Under 1 hour
1-2 hours
2-4 hours
4-6 hours
6+ hours
Prefer not to say
How would you rate your current skills relative to your goals?
Poor
Fair
Good
Very good
Excellent
How often do you dedicate focused time to learning or practice?
Very rarely
Rarely
Sometimes
Often
Very often
Which learning methods do you prefer?
Reading
Videos
Online courses
Hands-on practice
Mentorship or coaching
Podcasts
Communities or forums
Other
Please Specify:
I have clear, measurable goals for the next 90 days.
Strongly disagree
Disagree
Neither
Agree
Strongly agree
What is one key habit you will start or strengthen next?
How likely are you to achieve your top goal if you maintain your current habits?
0 Not at all likely
1
2
3
4
5 Extremely likely
I have the tools and resources I need to succeed.
Strongly disagree
Disagree
Neither
Agree
Strongly agree
Who do you turn to for accountability?
Friend or family
Colleague or manager
Community or group
Coach or mentor
App or digital tools
No one
Prefer not to say
What is working well for you right now?
What is your biggest obstacle at the moment?
Would you like a copy of your responses by email?
Yes
No
Email (optional)
I consent to the collection and processing of this information.
Yes
No
{"name":"What is your age?", "url":"https://www.quiz-maker.com/QPREVIEW","txt":"What is your age?, What is your gender?, What is your current primary focus?","img":"https://www.quiz-maker.com/3012/images/ogquiz.png"}
Paper art illustration depicting a self assessment survey form template for FormCreatorAI article

When to use this form

Use this form when you want a clear snapshot of how someone thinks they are performing and where they need support. It fits annual reviews, midyear check-ins, and project wrap-ups. Managers get context before 1:1s; employees organize wins, goals, and blockers. Use it alongside a Simple annual performance review form to compare self-ratings with manager feedback. New hires can complete it at 30/60/90 days to spot onboarding gaps. Sales reps can pair it with a Sales evaluation form to tie reflections to pipeline results. For ongoing growth, match it with a Self evaluation form to track progress over time. The outcome: focused conversations and concrete next steps.

Must Ask Self Assessment Survey Questions

  1. What results are you most proud of this period, and which metrics back them up?

    This prompts clear evidence of impact, not just activity. Numbers help you and your manager align on outcomes fast.

  2. Which goals did you miss or de-prioritize, and why?

    Owning tradeoffs surfaces blockers, risks, and dependencies. It guides where to adjust scope or support next.

  3. What strengths did you use most, and where did they create value?

    Identifying repeatable behaviors makes it easier to double down on what works. It also informs stretch assignments and mentoring.

  4. What skills, tools, or resources would help you improve next period?

    This turns vague development needs into a concrete plan for training or enablement. If you work on-site, align requests with the Construction employee evaluation form to connect safety and quality needs.

  5. What are your top three priorities for the next period, with milestones and target dates?

    Clear priorities translate reflection into action. Milestones create accountability and make progress easy to review later.

More Forms

Copy/Edit Form Send to Recipients Make a Form w/AI Form Builder Must Ask Questions
  • 100% Free - No Catches
  • Collect Responses Today
  • Tailor to your Look & Feel