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
You implement and facilitate controls and processes that maintain the integrity of the organization.
You accept accountability for your actions and results.
You are someone who is trustworthy.
You take ownership of mistakes and learn from them.
You develop goals and establishes objective measures of success.
Passion To Learn	Needs Significant Improvement	Could benefit from Development	Capable and Effective	Role Model
You inspire others to learn new things.
You will participate in training classes even if offered outside of normal working hours.
You enjoy learning new skills and techniques.
You embrace new technology and procedures.
You are committed to enhancing your own knowledge and skills.
Establishing Focus/Direction	Needs Significant Improvement	Could benefit from Development	Capable and Effective	Role Model
You make sure that employees understand and identify with the team's mission.
You maintain focus when handling several problems or tasks simultaneously.
You maintain self-control when personally criticized.
You align the department's goals with the goals of the organization.
You help guide employees with prioritizing tasks.
Persuasion and Influence	Needs Significant Improvement	Could benefit from Development	Capable and Effective	Role Model
You develop a good rapport with others.
You communicate effectively with others.
You ensure stakeholders are involved in the decision making process.
You persuade others to consider alternative points of view.
You attempt to persuade others rather than simply control them.
Innovation	Needs Significant Improvement	Could benefit from Development	Capable and Effective	Role Model
You solve problems with insight and understanding.
You suggest new ideas at meetings.
You take risks to advance important ideas.
You analyze current procedures and identify opportunities for improvement.
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 are determined to complete tasks regardless of obstacles that may occur.
You take reasonable risks to achieve desired results.
You are driven to complete assignments on time.
You are flexible in adjusting priorities to meet the demands of changing situations.
You rapidly complete tasks and assignments.
Interpersonal Skills	Needs Significant Improvement	Could benefit from Development	Capable and Effective	Role Model
You are a role model for others
You build a strong rapport with co-workers.
You demonstrate willingness to work with others.
You value the opinions of others.
You provide constructive feedback in a way that fosters acceptance and development.
Co-worker Development	Needs Significant Improvement	Could benefit from Development	Capable and Effective	Role Model
You take immediate action on poor performance
You work to identify root causes of performance problems
You adapt coaching and mentoring approach to meet the style or needs of individuals
You give others development opportunities through project assignments and increased job responsibilities
You set and clearly communicate expectations, performance goals, and measurements to others
Strategic Insight	Needs Significant Improvement	Could benefit from Development	Capable and Effective	Role Model
You create strategies that significantly benefit the Company.
You maintain knowledge of current trends in the industry.
You understand the Company's strengths and weaknesses and uses this information to create optimal solutions to problems.
You identify potential problems before they become critical incidents.
You analyze unique issues or problems impacting the Company.
Planning	Needs Significant Improvement	Could benefit from Development	Capable and Effective	Role Model
I can initiate the planning process by defining the scope of the project.
I am open to input from others into the plan for development of the strategic plan.
I can create effective logistics plans to achieve high operational efficiency.
I know how to create a timeline to specify when each phase of the project should be concluded.
I determine staffing needs for the project/department.

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.