Late Self-Assessment Form
Please complete the Late Self-Assessment Form to reflect on your recent experience, identify areas for improvement, and share your action plan.
Full Name
*
First Name
Last Name
Date of Assessment
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Please indicate the primary reason(s) for your lateness.
*
Unexpected personal issue
Workload management
Time misjudgment
Communication delay
Technical difficulties
Other
How would you rate your overall performance related to this task?
*
1
2
3
4
5
Please indicate your level of agreement with the following statements:
*
Rows
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
I understand the expectations for timely completion.
1
2
3
4
5
I took responsibility for communicating delays.
6
7
8
9
10
I had access to the resources needed.
11
12
13
14
15
I will take steps to improve timeliness.
16
17
18
19
20
How significant was the impact of your lateness?
*
No impact
1
2
3
4
Major impact
5
1 is No impact, 5 is Major impact
What actions have you already taken to address the lateness?
What is your action plan to prevent lateness in the future?
*
What support or resources would help you improve your timeliness?
Additional comments or reflections
Submit Assessment
Should be Empty: