Accountability - 360 Degree Feedback Survey Sample #6

360-Degree Assessment Survey

Dear Employee:

You have been selected to participate in a 360-assessment. As part of this process you will need to complete the self-assessment questionnaire below.

In responding to the questions below, think about your experiences over the last 12 months. The effectiveness of this development tool is dependent on your honest, forthright and constructive responses so please bear this in mind as you answer each question. Your responses will be aggregated with the responses received from others. A report will be shared with you at the conclusion of this project.

We encourage everyone to complete the survey. Please be honest, constructive and thoughtful in your input. The survey is designed to help us understand more about your thoughts and needs to make this a great company.

The results of this survey will be used to help drive our future success. We will report back to you about what you have said and what we plan to do about it. If you have any questions about the process please contact [Contact Person].

Please ensure that your submission is made between . The survey will only be available during these dates.

Thank you for your participation in the survey. We look forward to seeing the analysis of your responses and we are hoping for 100% participation.

Management Team

Accountability	Needs Significant Improvement	Could benefit from Development	Capable and Effective	Role Model
I honor the commitments and promises made to customers/clients.
I uphold ethical standards even when no one is watching.
I take personal responsibility for the quality of my work.
You consult with the supervisor before engaging in new procedures that have some risk.
I take full responsibility for results.
Passion To Learn	Needs Significant Improvement	Could benefit from Development	Capable and Effective	Role Model
You are open to feedback from others.
You enhance your value to the company through additional training and development.
You stay up-to-date on emerging technologies.
You embrace new technology and procedures.
You take advantage of training opportunities when they arise.
Establishing Focus/Direction	Needs Significant Improvement	Could benefit from Development	Capable and Effective	Role Model
You function well under stress, deadlines, and/or significant workloads.
You align the department's goals with the goals of the organization.
You maintain self-control when personally criticized.
You are excellent at managing time.
You stay focused even when under pressure and stress.
Persuasion and Influence	Needs Significant Improvement	Could benefit from Development	Capable and Effective	Role Model
You seek to obtain consensus or compromise.
You understand what others need.
You have excellent influencing/negotiating skills.
You ensure stakeholders are involved in the decision making process.
You persuade others to consider alternative points of view.
Innovation	Needs Significant Improvement	Could benefit from Development	Capable and Effective	Role Model
You foster a creative and innovative work environment.
You solve problems with insight and understanding.
You implement best practices within the department.
You offer constructive improvements to existing systems.
You search for opportunities and innovative ways to improve the organization.
Achievement	Needs Significant Improvement	Could benefit from Development	Capable and Effective	Role Model
You take calculated risks.
You allocate resources as needed to accomplish organizational goals.
You make use of talents of others to help achieve a high level of performance.
You take calculated risks to achieve higher levels of performance.
You strive to exceed standards of performance.
Interpersonal Skills	Needs Significant Improvement	Could benefit from Development	Capable and Effective	Role Model
You are able to work with individuals at all levels of the company.
I appreciate the extra efforts made by coworkers.
I work diligently to assist customers in finding the right products.
I offer praise to colleagues who have successfully completed major projects.
I offer constructive criticism to have a positive impact on performance.
Co-worker Development	Needs Significant Improvement	Could benefit from Development	Capable and Effective	Role Model
You set and clearly communicate expectations, performance goals, and measurements to others
You provide ongoing feedback to co-workers on your development progress
You give others development opportunities through project assignments and increased job responsibilities
You take immediate action on poor performance
You adapt coaching and mentoring approach to meet the style or needs of individuals
Strategic Insight	Needs Significant Improvement	Could benefit from Development	Capable and Effective	Role Model
I inspire employees to adopt the strategic plan.
You create strategic plans to develop and promote organizational and area strengths, as well as to address weaknesses based on insight from surveys.
You maintain knowledge of current trends in the industry.
I attend industry conferences to gain further insight into how other companies deal with similar issues.
You work with others to develop insights into the resources and actions required to produce desired results.
Planning	Needs Significant Improvement	Could benefit from Development	Capable and Effective	Role Model
You determine what supplies/equipment will be needed for the department.
I determine staffing needs for the project/department.
I am able to stay organized and focused using excellent planning skills.
I have plans to handle unexpected events.
I can adjust and rearrange the schedule to maximize efficiency.

51. Overall, please rate the effectiveness of [Participant Name Here].
    

    5- Very Effective 4- Effective 3- Neither 2- Ineffective 1- Very Ineffective

    
    
52. Describe the greatest strengths of this person with regard to his/her overall effectiveness in performing his/her current responsibilities.
    
    
    
53. Describe the most important things this person could improve upon in order to increase his/her overall effectiveness in performing his/her current responsibilities.
    
    
    
54. Additional comments, if any for [Participant Name Here]'s assessment.