Achievement - 360 Degree Feedback Survey Sample #5

360-Degree Assessment Survey

Dear Employee:

Thank you for providing feedback for the recipient above. As you respond, please draw on your first-hand experience with this individual in the past 12 months. Rate each item using the scale shown. If you don't feel you have enough first-hand information to rate a certain item, please choose the Not Applicable option. Comments can be very helpful; at a minimum where you give a particularly high or low rating, please share your reasons in the Closing Comments section. Your responses will be compiled with feedback from others and presented to the recipient to help guide their ongoing 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.

Please ensure that your submission is made by .

Thank you for your participation in the survey.

Management Team

Achievement	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Rapidly completes tasks and assignments.
Sets challenging goals for the department.
Inspires others to work with a sense of urgency.
Follows-up and takes action when goals are not met to ensure better results in the future.
Driven to complete goals despite obstacles that may arise.
Clarity	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Uses appropriate grammar and tense in communications.
Avoids creating ambiguity or mixed messages.
Makes sure employees understand why they were given certain assignments.
Clearly explains responsibilities to individuals.
Makes sure goals and objectives are clearly and thoroughly explained and understood.
Regulatory/Compliance	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Reviews skill levels of employees in areas of policies and regulations to identify gaps where additional training is needed.
Maintains compliance with federal, state, and local laws.
Implements regulatory changes in a timely manner.
Keeps up-to-date with legislation affecting employees.
Follows all safety regulations and procedures.
Client Focus	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Is pro-active in dealing with clients and addressing their needs.
Ensures client commitments and requirements are met or exceeded
Obtains feedback to ensure client needs are being met.
Looks for opportunities that have a positive impact on Clients.
Satisfies client needs.
Developing Others	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Encourages employees through recognition of positive changes in behavior.
Tries to ensure employees are ready to move to the next level.
Sets performance objectives for subordinates that encourages development opportunities.
Creates a work environment that fosters positive feedback to employees.
Assesses employees' developmental needs.
Others	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Works effectively with people from other departments.
Supports the efforts of other employees in implementing solutions to problems.
...treats others with respect and dignity.
Treats others with respect and dignity.
Helpful
Entrepreneurship	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Devotes a certain amount of time and effort to developing new business opportunities.
Finds unique ways to go around barriers to success.
Maintains a high level of energy to respond to demands of the job.
Encourages risk taking for developing potential business opportunities.
Balances risks and rewards when making decisions.

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

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

    
    
37. Strengths
    
    
    
38. Areas for Development
    
    
    
39. Please give any final comments or suggestions for [Participant Name Here]'s assessment.