Achievement - 360 Degree Feedback Survey Sample #1





360-Degree Feedback Survey

Questionnaires Measuring Achievement:
Survey 1 (4-point scale; Competency Comments)
Survey 2 (4-point scale; Competency Comments)
Survey 3 (5-point scale; Competency Comments)
Survey 4 (5-point scale; radio buttons)
Survey 5 (4-point scale; words)
Survey 6 (4-point scale; words)
Survey 7 (5-point scale; competency comments; N/A)
Survey 8 (3-point scale; Agree/Disagree words; N/A)
Survey 9 (3-point scale; Strength/Development; N/A)
Survey 10 (Comment boxes only)
Survey 11 (Single rating per competency)
Survey 12 (Slide-bar scale)
Instructions for Employees Participating in the 360-Feedback Assessment:

[Company] is conducting a 360-Degree Feedback Assessment developed by HR-Survey for selected managers.

You have been selected to receive feedback from a group of others. As part of this process, you will need to complete a self-assessment questionnaire at this time. Your feedback is an important part of our company's leadership development process and this survey 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 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 combined with the responses received from others and a report will be generated for you to foster growth and on-going 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.

Competencies Included:
Achievement, Interpersonal Skills, Coaching, Entrepreneurship, Action, Continual Learning, Adaptability, Leadership, Decision Making
Sample Result Document:
Sample Results
Your feedback is valuable in helping the individual to understand how they are perceived and experienced by others and the impact their behavior has on people in the organization with whom they interact. Feedback received also acknowledges strengths and identifies areas for development.

Use the form below to provide your feedback. Each field and comment box requires a response before you can SUBMIT your final feedback.

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


Achievement

Needs
Improvement
Meets
Minimum
Standards
Is
Proficient
Role
Model
  1. You inspire others to work with a sense of urgency.
  1. You strive to exceed standards of performance.
  1. You complete work to given time frame and to budget
  1. You are able to increase customer satisfaction scores for the quarter.
  1. I take calculated risks to achieve significant rewards.
  1. I am highly motivated to achieve performance goals.
If you were to make improvements in Achievement, what are your suggestions for how you can improve this?

Interpersonal Skills

Needs
Improvement
Meets
Minimum
Standards
Is
Proficient
Role
Model
  1. You influence others on your team to reach goals, improve performance, and try new things
  1. You successfully resolve conflicts and grievances to a win-win solution.
  1. You come across as credible, knowledgeable and sincere
  1. I demonstrate positive behaviors for others to follow.
  1. I recognize when others do a good job.
  1. I am a committed and reliable partner.
If you were to make improvements in Interpersonal Skills, what are your suggestions for how you can improve this?

Coaching

Needs
Improvement
Meets
Minimum
Standards
Is
Proficient
Role
Model
  1. You address employee behavior problems effectively.
  1. You provide clear, motivating, and constructive feedback.
  1. You coach employees in how to strengthen knowledge and skills to improve work performance.
  1. You help employees to understand responsibilities, authority, and expectations.
  1. You help employees to maintain high personal standards.
  1. You develop the skills and capabilities of others.
If you were to make improvements in Coaching, what are your suggestions for how you can improve this?

Entrepreneurship

Needs
Improvement
Meets
Minimum
Standards
Is
Proficient
Role
Model
  1. You take the initiative to complete tasks.
  1. You set business policies and procedures.
  1. You balance risks and rewards when making decisions.
  1. You understand the processes and various stages of business development.
  1. You are comfortable operating in an environment of uncertainty.
  1. You are excellent at managing relationships with stakeholders.
If you were to make improvements in Entrepreneurship, what are your suggestions for how you can improve this?

Action

Needs
Improvement
Meets
Minimum
Standards
Is
Proficient
Role
Model
  1. You make effective decisions, even when under pressure.
  1. I establish the tasks and direction for the team.
  1. You change course to meet the needs of a new situation.
  1. I pursue goals with action to achieve success.
  1. I persist in work despite obstacles encountered.
  1. You do whatever it takes (within reason) to get the job done.
If you were to make improvements in Action, what are your suggestions for how you can improve this?

Continual Learning

Needs
Improvement
Meets
Minimum
Standards
Is
Proficient
Role
Model
  1. You are introspective and aware of your own learning needs.
  1. You continue to ask questions about process and systems to further improve own knowledge.
  1. You take the initiative to learn new skills.
  1. You pursue professional development opportunities when they arise.
  1. I view setbacks as opportunities to learn from.
  1. You are curious about learning new things.
If you were to make improvements in Continual Learning, what are your suggestions for how you can improve this?

Adaptability

Needs
Improvement
Meets
Minimum
Standards
Is
Proficient
Role
Model
  1. You are open to new ideas and innovations.
  1. You easily accept new responsibilities.
  1. You are able to adapt to new environments.
  1. You are able to adjust plans to meet new situations.
  1. You embrace changes in technology and automation.
  1. You can adjust plans and procedures.
If you were to make improvements in Adaptability, what are your suggestions for how you can improve this?

Leadership

Needs
Improvement
Meets
Minimum
Standards
Is
Proficient
Role
Model
  1. You encourage dialogue to clarify decision making and inform staff
  1. You are a highly effective supervisor.
  1. You actively listen for feedback from subordinates.
  1. You hold team members accountable to commitments made
  1. You set specific, measurable, and challenging goals.
  1. You lead team to set goals, solve problems, and accomplish tasks.
If you were to make improvements in Leadership, what are your suggestions for how you can improve this?

Decision Making

Needs
Improvement
Meets
Minimum
Standards
Is
Proficient
Role
Model
  1. You use reasonable assumptions and logic to decide between alternate courses of action
  1. You remain focused on the immediate goal when making decisions.
  1. I carefully evaluate information before making an important decision.
  1. You coach team members individually when "poor" decisions are made and helps them see what could have been done differently
  1. I examine for patterns in data to help predict future possibilities.
  1. I am able to make decisions quickly.
If you were to make improvements in Decision Making, what are your suggestions for how you can improve this?

  1. What are [Participant Name Here]'s greatest strengths demonstrated this year?


  2. What are [Participant Name Here]'s areas for development?


  3. Please give any final comments or suggestions for [Participant Name Here]'s assessment.