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360 Feedback Survey Example 1

This example questionnaire shows how comments can be an integral part of the survey. In this example, a comment box is provided for each rating made by the participant. These written comments provide valuable feedback in more detail than just a single rating.

ABC Global 360-Degree Feedback


Rater:

You are providing feedback to:

Instructions

You have been selected to provide feedback for the manager listed above. Your feedback is an important part of '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 and presented to the manager to guide them in their on-going development. Comments will be shared anonymously as written with the manager, unless you indicate otherwise.

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.

Your questionnaire can be customized to include competencies and items relevant for your needs. Competencies and items can vary depending on job classification or other demographic factors.

To what extent does ____________ exhibit the following ...


Rater:
You are providing feedback to:


Instructions

You have been asked to evaluate yourself as part of a 360-degree feedback process. Other employees, including your manager(s), peers, direct reports and/or others will also evaluate you. In this manner, you will be provided with a comprehensive, multi-perspective (i.e., 360-degree) view of your performance. The objective is to provide you with feedback so as to allow you to improve your performance, resulting in improved team performance, and organizational effectiveness.


    Accountability

    Needs
    Improvement
    Could Benefit
    from
    Development
    Performs
    as
    Expected
    Excels;
    Above
    Average
    Is a
    Role Model
    for Others
    Don't
    Know
    1. Acts like an owner when they make decisions
    1. Can be counted on to do what they say they are going to do
    1. Remains knowledgeable of Company performance
    1. Defines roles, rights, and responsibilities of employees
    1. Tackles issues head on and finds solutions
    1. Takes responsibility for results
    1. Takes ownership of mistakes and learns from them
    1. Is someone you can trust
    1. Is someone who is there when you need them
    1. Encourages employees to take on greater responsibilities
    1. Informs supervisor of progress without having to be asked about it
    1. Is aware of problems or issues that may affect the organization
    Do you have any additional comments about this individual's job performance for this area? If so, please explain.

    Communication Skills

    Needs
    Improvement
    Could Benefit
    from
    Development
    Performs
    as
    Expected
    Excels;
    Above
    Average
    Is a
    Role Model
    for Others
    Don't
    Know
    1. Accurately attends to/understands ideas which are exchanged
    1. An effective listener who is responsive to information needs
    1. Checks for understanding throughout conversations or group presentations/discussions
    1. Communicates the vision of the organization to all employees
    1. Conducts regular performance feedback discussions with individuals and teams
    1. Considers the audience in how the communication is presented
    1. Conveys ideas confidently and succinctly
    1. Conveys priorities with right sense of urgency and importance
    1. Deal with difficult situations calmly and confidently
    1. Delivers difficult messages to co-workers in an appropriate manner
    1. Informs others about changes or developments in plans and goals
    1. Explains reasons behind decisions and actions
    1. Has the confidence to communicate effectively to all levels (from CEO down) of the organization, external customers, suppliers, as well as the senior counsel of other companies.
    1. Inspires others to take action based on his/her communications
    1. Listens actively & speaks clearly and directly.
    1. Reviews any "action steps" resulting from meetings or conversations before concluding to ensure clarity and that plans will be executed
    1. Takes time to listen to you
    1. Is visible and approachable
    1. Presents issues, ideas, and strategy concisely and clearly
    Do you have any additional comments about this individual's job performance for this area? If so, please explain.

    Feedback

    Needs
    Improvement
    Could Benefit
    from
    Development
    Performs
    as
    Expected
    Excels;
    Above
    Average
    Is a
    Role Model
    for Others
    Don't
    Know
    1. Accepts the views of others
    1. Actively seeks feedback from others
    1. Asks others for their ideas and opinions
    1. Is easy to approach with ideas and opinions
    1. Looks to others for input
    1. Seeks and utilizes data from several sources
    1. Seeks feedback to enhance performance
    Do you have any additional comments about this individual's job performance for this area? If so, please explain.

    Leadership

    Needs
    Improvement
    Could Benefit
    from
    Development
    Performs
    as
    Expected
    Excels;
    Above
    Average
    Is a
    Role Model
    for Others
    Don't
    Know
    1. Maximizes the efforts of all team members
    1. Uses persuasion and influence instead of micromanaging employees
    1. Able to influence others
    1. Able to align manpower, design work, an allocate tasks to achieve goals
    1. Able to organize the work of others
    1. Acts decisively in implementing decisions
    1. Coaches core team to document and hold co-workers accountable for assignments and commitments
    1. Critiques own performance as a means of self-improvement and initiates self-development activities
    1. Demonstrates empathy for the impact of change on people and processes
    1. Empowers others to achieve results and holds them accountable for actions
    1. Encourages and is receptive to working out problems and challenges --- no reluctance from team members to come forward with concerns/issues
    1. Empowers others to succeed within their jobs
    1. Implements decision and evaluates results
    1. Inspires a shared vision of being the best
    1. Looks for opportunities to enhance contributions to the bottom line
    1. Motivates others to reach and exceed organizational goals and objectives
    1. Performs effectively, even under frustrating or challenging work conditions
    1. Projects a "can-do" attitude when interfacing with peers, subordinates and customers(especially during difficult and challenging times)
    1. Supports Company sponsored training and development initiatives
    1. Takes ownership and accountability for results
    Do you have any additional comments about this individual's job performance for this area? If so, please explain.

    Problem Solving

    Needs
    Improvement
    Could Benefit
    from
    Development
    Performs
    as
    Expected
    Excels;
    Above
    Average
    Is a
    Role Model
    for Others
    Don't
    Know
    1. Ability to solve problems at root cause rather than at symptom level
    1. Able to develop innovative solutions to problems
    1. Analyzes alternatives and selects a course of action
    1. Assumes new and difficult challenges and manages them as opportunities
    1. Collects relevant information and data
    1. Identifies fresh approaches and shows a willingness to question traditional assumptions
    1. Implements solutions and evaluates results
    1. Makes judgments based upon relevant information
    1. Open to the suggestions of others when working on a problem
    1. Analyzes systems and processes for opportunities to gain efficiency
    1. Selects operating indicators to track organizational performance over time and communicates current status to the organization
    1. Willingness and comfort level in handling multiple and often times conflicting priorities
    Do you have any additional comments about this individual's job performance for this area? If so, please explain.

    Teamwork

    Needs
    Improvement
    Could Benefit
    from
    Development
    Performs
    as
    Expected
    Excels;
    Above
    Average
    Is a
    Role Model
    for Others
    Don't
    Know
    1. Creates a culture that fosters and values collaboration
    1. Comes across as a reliable, committed team member
    1. Contributes to and supports team decision-making process
    1. Creates and implements team reward and recognition programs
    1. Creates opportunities to learn with other team members
    1. Demonstrates compassion and respect for others through actions; is concerned about their work and non-work issues
    1. Encourages Open Communication
    1. Ensures that the right people are on the team in the appropriate roles, including who should be team leader for a particular project/situation.
    1. Facilitates conflict resolution discussions between individuals in different teams
    1. Facilitates team discussions and problem-solving
    1. Fosters teamwork rather than individual competition
    1. Helps other managers in need of assistance, such as providing needed resources (co-workers, supplies, etc.)
    1. Is open to new ideas that may change own goals for benefit of the team
    1. Partners with people from other work units to improve overall performance
    1. Promotes open participation and communication within department and throughout the organization.
    1. Relates to all kinds of people tactfully, from shop floor to executives
    1. Creates a climate that encourages team participation
    Do you have any additional comments about this individual's job performance for this area? If so, please explain.





    Strengths:


    Opportunities for Development: