Achievement - 360 Degree Feedback Survey Sample #12

360 Feedback Survey

Instructions

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 comment section for that competency. 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.

To what extent does [Participant Name] exhibit the following ...

SELECT the rating that best reflects the employee's performance in the areas listed.

Achievement

• Helps others to improve or meet standards of performance.
• Sets ambitious standards of performance.
• Establishes stretch goals to advance skills and output.
• Demonstrates improvement in performance.
• Follows-up and takes action when goals are not met to ensure better results in the future.

Needs Improvement		Fully Proficient		Excels/ Role Model
Click this box to make your rating

Comments:

Continual Improvement

• Open to the suggestions from others.
• Looks for ways to improve work processes and procedures.
• Looks for ways to expand current job responsibilities.
• Searches for new methods, techniques, and processes that increase efficiency and reduce costs.
• Analyzes processes to determine areas for improvement.

Needs Improvement		Fully Proficient		Excels/ Role Model
Click this box to make your rating

Comments:

Attitude

• Is gracious and professional in their interactions with others.
• Treats all people fairly and with respect.
• Works to eliminate unnecessary work or barriers that get in others' way.
• Contributes to a positive work environment.
• Builds open and trusting relationships.

Needs Improvement		Fully Proficient		Excels/ Role Model
Click this box to make your rating

Comments:

Regulatory/Compliance

• Complies with regulatory requirements for the state.
• Addresses issues quickly before they develop into major problems.
• Knows who to contact at various regulatory agencies if needed.
• Performs audits regularly, or without notice, to ensure proper compliance with regulations.
• Creates documents and reports as needed to maintain compliance with regulations.

Needs Improvement		Fully Proficient		Excels/ Role Model
Click this box to make your rating

Comments:

Strategic Focus

• Focuses attention on treating the causes of problems rather than simply addressing the symptoms.
• Communicates goals and objectives to employees.
• Understands & contributes to development of strategic goals.
• Creates plans to develop and promote organizational and area strengths, as well as to address weaknesses.
• Sustains or achieves a competitive advantage for the organization by analyzing the best practices and lessons learned from other organizations.

Needs Improvement		Fully Proficient		Excels/ Role Model
Click this box to make your rating

Comments:

Strengths


Areas for Development


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