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)
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


Action

Needs
Improvement
Meets
Minimum
Standards
Is
Proficient
Role
Model
  1. Conducts critical-incident review immediately after the event.
  1. Is decisive when making decisions.
  1. Sets high standards for themselves and others.
  1. Fixes small issues before they become critical incidents.
  1. Addresses performance issues quickly.
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. Pursues learning that will enhance job performance.
  1. Builds on their strengths while addressing their weaknesses.
  1. Takes charge of their training and skills enhancement.
  1. Sets relevant learning objectives and goals.
  1. Shares best practices with others and learns from others.
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. Able to influence others.
  1. Holds others accountable for their actions.
  1. Motivates others to reach and exceed organizational goals and objectives.
  1. Clearly explains performance expectations and goals to be reached at the beginning of a project, then let's others decide how to achieve the goal.
  1. Sets a high level of performance expectations and challenges others to do the same.
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. Sets clear and reasonable expectations for others and follows through on their progress.
  1. Assigns tasks to create learning opportunities for the employees.
  1. Entrusts subordinates with important tasks.
  1. Delegates authority and responsibility to subordinates and holds them accountable for their actions.
  1. Defines the roles, responsibilities, required actions, and deadlines for team members.
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. Recognizes and implements changes to enhance efficiency and effectiveness.
  1. Performs a wide range of tasks, responds to changes in direction and priorities and accepts new challenges, responsibilities, and assignments.
  1. Adjusts priorities to changing business goals.
  1. Is aware of changes to the policies and procedures.
  1. Handles unexpected events without a loss of productivity.
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. Coordinates the work of a team by assigning tasks to other team members.
  1. Organizes tasks for the most efficient order of completion.
  1. Determines which tasks are critical and which tasks are optional.
  1. Assesses current capabilities before committing to new requests from customers.
  1. Recognizes and responds to product placement and signing needs while staying alert to customers' needs, store activities and training associates.
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. Strives to lead by example to demonstrate the value of interpersonal relationships.
  1. Anticipates the concerns of other employees.
  1. Gives good advice and suggestions to coworkers.
  1. Sees values in the diversity of individuals on the team.
  1. Honest about owning up to mistakes made.
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. Provides ongoing feedback to co-workers on their development progress
  1. Sets and clearly communicates expectations, performance goals, and measurements to others
  1. Works to identify root causes of performance problems
  1. Adapts coaching and mentoring approach to meet the style or needs of individuals
  1. Gives others development opportunities through project assignments and increased job responsibilities
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. Consistently demonstrates ability and willingness to trust others.
  1. ...treats others with respect and dignity.
  1. Supports the efforts of other employees in implementing solutions to problems.
  1. Is able to see issues from others' perspectives.
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. Encourages risk taking for developing potential business opportunities.
  1. Encourages dynamic growth opportunities.
  1. Understands the processes and various stages of business development.
  1. Balances risks and rewards when making decisions.
  1. Is comfortable operating in an environment of uncertainty.
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.