Achievement - 360 Degree Feedback Survey Sample #4

Dear Employee:


Welcome to our 360-Degree Feedback Assessment of [Participant Name]. Our objective is to provide feedback which will help advance his/her leadership skills and capabilities. We are asking you to take time to respond to this survey to help us identify where we are doing well and where we have opportunities to do better.

We have developed this survey with questions tailored for [Participant Name]'s position in the department to provide you with an opportunity to anonymously rate many facets of his/her leadership performance. The survey will assess what you value most in their leadership skills and allow you to make positive suggestions for improvement.

Please be honest, constructive and thoughtful in your responses. The results of this survey will be used to help drive our future success. 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

Instructions:
Please complete the items below and press the submit button at the end of the survey. If you need multiple sessions to complete the survey, please click the "Submit" button at the end of each session to save your responses. Please feel free to skip any items that you do not wish to respond to. Keep in mind that your responses help us to become a better place to work. So, you are encouraged to respond to all items on the questionnaire.

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Achievement	Needs Significant Development 1	2	Capable and Effective 3	4	Role Model 5
Driven to complete goals despite obstacles that may arise.
Is determined to complete tasks regardless of obstacles that may occur.
Accepts setbacks and challenges as improvement opportunities
Rapidly completes tasks and assignments.
Inspires others to work with a sense of urgency.
Commitment To Result	Needs Significant Development 1	2	Capable and Effective 3	4	Role Model 5
Willing to do whatever it takes-not afraid to have to put in extra effort.
Able to focus on a task even when working alone.
Takes immediate action toward goals.
Maintains persistence and dedication to achieving results.
Committed to the team.
Safety	Needs Significant Development 1	2	Capable and Effective 3	4	Role Model 5
Participates in safety training when available.
Identifies predictable hazards in the workplace.
Develops safety guidelines for the department.
Supports our company's safety programs.
Ensures that all supervisors are aware of regulatory and compliance measures.
Flexibility	Needs Significant Development 1	2	Capable and Effective 3	4	Role Model 5
Effective in incorporating new ideas.
Adapts to new organizational structures, policies, or procedures.
Willing to try new ideas.
Open to the perspectives/viewpoints of others.
Works effectively during periods of change.
Bias for Action	Needs Significant Development 1	2	Capable and Effective 3	4	Role Model 5
Coach others to foster an environment which can adapt quickly and willingly to rapid change.
Displays high energy and enthusiasm on consistent basis.
Motivates others to achieve or exceed goals
Conveys a sense of urgency about addressing problems and opportunities
Projects a "can-do" attitude when interfacing with peers, subordinates and customers(especially during difficult and challenging times).
Cultural Awareness	Needs Significant Development 1	2	Capable and Effective 3	4	Role Model 5
Is open and honest in communications with individuals from other cultures.
Interacts effectively with people from different cultural backgrounds.
Recognizes individual and cultural differences.
Respects the views offered by individuals with different cultural backgrounds.
Willing to work with employees who have different cultural backgrounds.
Analytical	Needs Significant Development 1	2	Capable and Effective 3	4	Role Model 5
Balances risks and costs with the rewards and probabilities of success when decisions.
Identifies the root cause of a problem.
Asks the "right" questions to size up or evaluate situations.
Analyzes data and information from several sources and arrives at logical conclusions.
Analyzes issues and reduces them to their component parts.
Initiative	Needs Significant Development 1	2	Capable and Effective 3	4	Role Model 5
Anticipates what needs to be done and makes necessary preparations.
Prepares for unexpected contingencies.
Acts quickly when an opportunity becomes available.
Expands the offerings of the department by working evenings and weekends.
Takes action without being asked.
Innovation	Needs Significant Development 1	2	Capable and Effective 3	4	Role Model 5
Develops new products and services.
Offers constructive improvements to existing systems.
Finds creative ways to get things done with limited resources.
Implements best practices within the department.
Challenges current procedures to develop other alternatives.

46. On a scale of Excellent to Poor, how would you rate your overall employment with [Company] and why?
    

    -Excellent -Good -Average -Poor




47. Would you refer others who are seeking employment to [Company]?
    Yes No
    
    Please provide explanation:
    
    


48. If you had an opportunity to make any change you wanted to make [Company] a better place to work, what one improvement would you make?
    
    
    


49. What changes do you see [Company] making in order to raise the standards?
    
    


50. I feel good about my continued employment with [Company].
    Yes No
    
    If no, please provide explanation:
    
    
    


51. What do you like best about working for [Company]?
    
    


52. What do you like least about working for [Company]? How could it be improved?
    


93. Use the space below to enter any final comments you would like to be noted: