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. Completes tasks on time in spite of delays in the process.
  1. Starts immediately working on assignments.
  1. Converts plans into actions.
  1. Takes responsibility for actions.
  1. Takes responsibility for meeting performance standards.
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. Pursues professional development opportunities when they arise.
  1. Takes charge of their training and skills enhancement.
  1. Seeks opportunities to grow in skills and knowledge.
  1. Pursues self-improvement through continual learning.
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. Provides resources to enable individuals to develop professionally.
  1. Motivates others to reach and exceed organizational goals and objectives.
  1. Motivates and challenges employees to attain a shared vision.
  1. Expresses clear goals and objectives.
  1. Is a highly effective supervisor.
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. Delegates authority and responsibility to subordinates and holds them accountable for their actions.
  1. Tells subordinates what to do, not how to do it.
  1. Defines the roles, responsibilities, required actions, and deadlines for team members.
  1. Allows employees to decide how they wish to complete the tasks.
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. Handles unexpected events without a loss of productivity.
  1. Adjusts plans as needed based on changing conditions.
  1. Adapts to diversity within the team.
  1. Recognizes and implements changes to enhance efficiency and effectiveness.
  1. Adjusts tactics when things are not working as expected.
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. Plans and organizes continuously while performing all other responsibilities and activities.
  1. Can multitask while performing all of their other responsibilities and activities.
  1. Is aware of the deadlines for specific tasks/assignments.
  1. Begins tasks as soon as possible.
  1. Determines which tasks are critical and which tasks are optional.
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. Considers the other individual's point of view.
  1. Demonstrates willingness to work with others.
  1. Expresses appreciation of other's work.
  1. Effectively manages conflicts by dealing with them directly and immediately
  1. Sees values in the diversity of individuals on the team.
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. Sets and clearly communicates expectations, performance goals, and measurements to others
  1. Takes immediate action on poor performance
  1. Provides ongoing feedback to co-workers on their development progress
  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. Supports the efforts of other employees in implementing solutions to problems.
  1. Works effectively with people from other departments.
  1. Helpful
  1. Forms working relationships with employees from other departments.
  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. Devotes a certain amount of time and effort to developing new business opportunities.
  1. Understands the processes and various stages of business development.
  1. Finds unique ways to go around barriers to success.
  1. Seeks and utilizes mentors to help guide professional 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.