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Sample 360-Degree Feedback Questionnaire 25

ABC Global 360-Degree Feedback

Rater: [Your Name]
You are providing feedback to: [Participant Name]

You have been selected to provide feedback for the manager listed above. Your feedback is an important part of Demo Client's leadership development process. This tool is intended to gather broad feedback in the core competencies and role responsibilities that are important for the on-going success of our organization.

In responding to the assessment form, please think about your experiences working with this individual during the last twelve months. Your responses will be merged with other's feedback to guide them in their on-going development. Comments will be shared anonymously as written.

Method of use: As part of the annual appraisal process, leaders receive feedback from peers, subordinates, customers and supervisors. It is recognized that not all participants will be able to assess an individual's performance in all areas. The feedback received will be utilized as input to the individual's annual appraisal and development plan.

Performance Rating Guide:
Excels/Role model. Results consistently exceed expectations. Makes significant contributions well beyond requirements. Outpaces the majority of peers.
Fully Proficient. Results are fully and consistently on target. Makes a valuable contribution. Is fully competent. This level describes performance of the majority of employees.
Needs improvement. Improvement clearly needed. Is inconsistent in performance and requires excessive supervision and support. An action plan for improvement in this area needed.

Instructions:
Below each item is a small box that contains the statement: "Click this box to make your rating". Each box has a rating scale with three anchors (see above). Click the box along the scale where you feel the rating should be made. You may also drag the mouse over the rating scale to make your rating.

Instructions

Thank you for providing your self-feedback. As you respond, please draw on your first-hand experience in the past 12 months. Rate each item using the scale shown. If you don't feel you have enough first-hand experience to rate a certain item, please choose the Not Applicable option. Comments can be very helpful; at a minimum where you give a particularly high or low rating, please share your reasons in the Closing Comments section. Your responses will be compiled with feedback from others to help guide you on your ongoing leadership development.

Partially completed forms can be saved by using the Save/Still Working button at the bottom of the page. You may return at a later time to complete/edit the form. Your saved responses will be shown each time you re-visit the feedback form. When you are certain that you have completed your responses and will be not making any changes, click the Complete button.

To what extent do you demostrate the following ...

Closing Comments

Describe the greatest strengths of Laura Allen with regard to her overall effectiveness in performing her current responsibilities.

Describe the most important things Laura Allen could improve upon in order to increase her overall effectiveness in performing her current responsibilities.

Status of the Form

Upon clicking this button any responses will be saved. You can still return to the form to enter/review responses.

Strategic Insight	Not Applicable	Never demonstrates this skill	Seldom demonstrates this skill	Sometimes demonstrates this skill	Usually demonstrates this skill	Always demonstrates this skill
Implements long-term solutions to problems.
Identifies root causes of problems.
Analyzes unique issues or problems impacting the Company.
Communicates vision for the department and company.
Formulates strategies and action plans to ensure successful completion of goals and objectives.
Understands & contributes to development of strategic goals.

Entrepreneurship	Not Applicable	Never demonstrates this skill	Seldom demonstrates this skill	Sometimes demonstrates this skill	Usually demonstrates this skill	Always demonstrates this skill
Finds unique ways to go around barriers to success.
Exhibits determination and passion in completion of goals.
Excellent at managing relationships with stakeholders.
Able to adapt the department to changing business demands and climate.
Encourages risk taking for developing potential business opportunities.
Has a strategic awareness on how to promote the organization.

Communication Skills	Not Applicable	Never demonstrates this skill	Seldom demonstrates this skill	Sometimes demonstrates this skill	Usually demonstrates this skill	Always demonstrates this skill
An effective listener who is responsive to information needs.
Communicates effectively with colleagues and customers
Deals with difficult situations calmly and confidently.
Asks follow-up questions as needed.
Communicates effectively with all levels of the organization.
Gives clear and convincing presentations.

Accountability	Not Applicable	Never demonstrates this skill	Seldom demonstrates this skill	Sometimes demonstrates this skill	Usually demonstrates this skill	Always demonstrates this skill
Can be counted on to do what they say they are going to do.
Takes ownership of mistakes and learns from them.
Tackles issues head on and finds solutions.
Takes responsibility for results.
Is someone you can trust.
Requires employees to submit action plans, timelines or other objectives.

Professional Presence	Not Applicable	Never demonstrates this skill	Seldom demonstrates this skill	Sometimes demonstrates this skill	Usually demonstrates this skill	Always demonstrates this skill
Develops a reputation as a "go-to" resource sought out by others
Gains commitment by persuading, not by demanding
Commands the attention of an audience of one or many
Remains focused on guiding others towards most important objectives (ensure execution)
Creates a professional image that establishes and maintains credibility
Establishes influential contacts both inside and outside the company

Action	Not Applicable	Never demonstrates this skill	Seldom demonstrates this skill	Sometimes demonstrates this skill	Usually demonstrates this skill	Always demonstrates this skill
Displays high energy and enthusiasm on consistent basis.
Effectively makes decisions
Makes effective decisions, even when under pressure.
Does whatever it takes (within reason) to get the job done.

Attitude	Not Applicable	Never demonstrates this skill	Seldom demonstrates this skill	Sometimes demonstrates this skill	Usually demonstrates this skill	Always demonstrates this skill
Treats all people fairly and with respect.
Builds open and trusting relationships.
Contributes to a positive and fun work environment.
Works to eliminate unnecessary work or barriers that get in others' way.
Shows by their actions that they trust in the positive intentions of others.
Visibly supports and encourages diversity in style and background.

	Upon clicking this button any responses will be saved. You can still return to the form to enter/review responses.

Sample 360-Degree Feedback Questionnaire 25

Rater: [Your Name] You are providing feedback to: [Participant Name]

Instructions

Strategic Insight

Entrepreneurship

Communication Skills

Accountability

Professional Presence

Action

Attitude

Closing Comments

Status of the Form

Rater: [Your Name]
You are providing feedback to: [Participant Name]