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Action - 360 Degree Feedback Survey Sample #1





360-Degree Feedback Survey

Questionnaires Measuring Action:
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)
Survey 13 (4-point scale; numbers; floating anchors)
Survey 14 (4-point scale; N/A)
Instructions:

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

You have been selected to provide feedback on the employee listed above. 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 working with this employee over the last twelve 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 and discussed with the employee 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:
Action, Continual Learning, Leadership, Delegation, Adaptability, Juggling Multiple Responsibilities, Interpersonal Skills, Co-worker Development, Others, Entrepreneurship
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
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Action

Needs
Improvement
Meets
Minimum
Standards
Is
Proficient
Role
Model
  1. Works quickly when faced with difficult problems.
  1. Completes challenging projects successfully despite setbacks.
  1. Persists in work despite obstacles encountered.
  1. Displays high energy and enthusiasm on consistent basis.
  1. Takes advantage of opportunities to move the organization forward.
If [Participant Name] were to make improvements in Action, what are your suggestions for how he/she can improve this?

Continual Learning

Needs
Improvement
Meets
Minimum
Standards
Is
Proficient
Role
Model
  1. Takes charge of their training and skills enhancement.
  1. Takes the initiative to learn new skills.
  1. Sets relevant learning objectives and goals.
  1. Grasps new ideas, concepts, technical, or business knowledge.
  1. Seeks opportunities to grow in skills and knowledge.
If [Participant Name] were to make improvements in Continual Learning, what are your suggestions for how he/she can improve this?

Leadership

Needs
Improvement
Meets
Minimum
Standards
Is
Proficient
Role
Model
  1. Acts decisively in implementing decisions.
  1. Effectively leads others.
  1. Demonstrates leadership and courage in critical situations.
  1. Expresses clear goals and objectives.
  1. Sets clear goals and objectives for subordinates.
If [Participant Name] were to make improvements in Leadership, what are your suggestions for how he/she can improve this?

Delegation

Needs
Improvement
Meets
Minimum
Standards
Is
Proficient
Role
Model
  1. Defines goals and objectives for subordinates.
  1. Encourages and empowers subordinates to use initiative in achieving goals and objectives.
  1. Allows employees to decide how they wish to complete the tasks.
  1. Delegates tasks, responsibilities, and accountability as appropriate to the level of employee.
  1. Delegates authority and responsibility to subordinates and holds them accountable for their actions.
If [Participant Name] were to make improvements in Delegation, what are your suggestions for how he/she can improve this?

Adaptability

Needs
Improvement
Meets
Minimum
Standards
Is
Proficient
Role
Model
  1. Is open to changes in policies and procedures.
  1. Adjusts tactics when things are not working as expected.
  1. Is flexible when dealing with changes.
  1. Can take on new assignments.
  1. Adjusts plans to meet new situations.
If [Participant Name] were to make improvements in Adaptability, what are your suggestions for how he/she can improve this?

Juggling Multiple Responsibilities

Needs
Improvement
Meets
Minimum
Standards
Is
Proficient
Role
Model
  1. Spends the most time and effort on critical tasks first.
  1. Prioritizes tasks for efficiency.
  1. Builds in extra time in the schedule for unplanned events/occurrences.
  1. Observes, analyzes, and responds to merchandise needs while serving customers and accomplishing operational tasks.
  1. Is aware of the deadlines for specific tasks/assignments.
If [Participant Name] were to make improvements in Juggling Multiple Responsibilities, what are your suggestions for how he/she can improve this?

Interpersonal Skills

Needs
Improvement
Meets
Minimum
Standards
Is
Proficient
Role
Model
  1. Follows up on inquiries in a timely manner.
  1. Easily approachable.
  1. Sees values in the diversity of individuals on the team.
  1. Expresses appreciation of other's work.
  1. Adapts management style to meet the needs of the individual or situation.
If [Participant Name] were to make improvements in Interpersonal Skills, what are your suggestions for how he/she can improve this?

Co-worker Development

Needs
Improvement
Meets
Minimum
Standards
Is
Proficient
Role
Model
  1. Takes immediate action on poor performance
  1. Gives others development opportunities through project assignments and increased job responsibilities
  1. Works to identify root causes of performance problems
  1. Adapts coaching and mentoring approach to meet the style or needs of individuals
  1. Provides ongoing feedback to co-workers on their development progress
If [Participant Name] were to make improvements in Co-worker Development, what are your suggestions for how he/she can improve this?

Others

Needs
Improvement
Meets
Minimum
Standards
Is
Proficient
Role
Model
  1. Constructively receives criticism and suggestions from others.
  1. Supports the efforts of other employees in implementing solutions to problems.
  1. Works across boundaries within the organization.
  1. Treats others with respect and dignity.
  1. ...treats others with respect and dignity.
If [Participant Name] were to make improvements in Others, what are your suggestions for how he/she can improve this?

Entrepreneurship

Needs
Improvement
Meets
Minimum
Standards
Is
Proficient
Role
Model
  1. Is comfortable operating in an environment of uncertainty.
  1. Seeks and utilizes mentors to help guide professional development.
  1. Excellent at managing relationships with stakeholders.
  1. Encourages risk taking for developing potential business opportunities.
  1. Understands the processes and various stages of business development.
If [Participant Name] were to make improvements in Entrepreneurship, what are your suggestions for how he/she 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.