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Self Reflection Survey Form Template

Gain insights into your strengths and areas for growth

If you're looking to understand yourself better, a self-reflection survey can be an invaluable tool. This template helps you uncover your strengths and weaknesses, enabling personal growth and goal achievement. Use it to set actionable objectives, track your progress over time, and enhance your overall self-awareness. By taking the time to reflect, you can foster a deeper understanding of your motivations and desires, leading to more informed life choices. Try the live template and start your journey of personal discovery today.

Which time period are you reflecting on?
Today
Past week
Past two weeks
Past month
Past quarter
Past year
Other / not specific
Overall, how satisfied were you during this period?
Very dissatisfied
Dissatisfied
Neutral
Satisfied
Very satisfied
How would you describe your overall mood during this period?
Very unhappy
Unhappy
Neutral
Happy
Very happy
How often did you feel stressed?
Never
Rarely
Sometimes
Often
Always
Maintaining your energy levels was...
Very difficult
Difficult
Neutral
Easy
Very easy
I stayed focused on my top priorities.
Strongly disagree
Disagree
Neither agree nor disagree
Agree
Strongly agree
I made meaningful progress toward my important goals.
Strongly disagree
Disagree
Neither agree nor disagree
Agree
Strongly agree
How often did you get at least 7 hours of sleep?
Never
Rarely
Sometimes
Often
Always
What strengths did you use most during this period?
What were the main challenges or blockers you encountered?
What is your top priority goal for the next period?
What is one specific next action you will take?
What support or resources would help you follow through?
How likely are you to complete this next action?
0 Not at all likely
1
2
3
4
5 Extremely likely
How would you rate your overall performance this period?
Poor
Fair
Good
Very good
Excellent
What is the most important insight you gained?
Anything else you would like to note?
Compared with the previous period, your progress was...
Much worse
Worse
About the same
Better
Much better
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Paper art illustration featuring a self reflection survey form with checkboxes and writing spaces

When to use this form

Use this form after a project wrap-up, at quarter or mid-year checkpoints, or when setting new goals. It helps employees, students, and freelancers step back, capture wins, and spot gaps. Managers can pair it with a Mid year performance review form to guide a balanced conversation. L&D teams can use patterns from responses to plan training with a Skill gap analysis report form. In schools, learners can reflect after a research paper or lab. The result is a clear set of priorities for the next 3090 days and specific actions you will take.

Must Ask Self Reflection Survey Questions

  1. What are your top three achievements from this period, and what made them possible?

    Focusing on concrete wins surfaces the behaviors and resources you should repeat. It also gives you measurable examples to use in a manager check-in or review.

  2. Which goals did you miss or delay, and what blocked progress?

    Naming obstacles turns vague frustration into issues you can fix. This helps you propose solutions and timelines instead of excuses.

  3. What feedback did you receive, and how did you act on it?

    Linking feedback to actions shows growth and accountability. It also sets up a better discussion alongside an Employee performance evaluation form.

  4. Which skills or habits will you focus on next, and why do they matter?

    This ties your reflection to future impact, so your plan stays relevant. Defining the why boosts follow-through and helps you choose the right learning path.

  5. What is one change you will try in the next 30 days, and how will you measure success?

    A small, time-bound experiment lowers risk and speeds learning. Picking a metric forces clarity and makes progress visible.

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