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Action - 360 Degree Feedback Survey Sample #2





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

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 and the goals they were asked to achieve. 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 discussed with the employee to foster growth and on-going development.

Competencies Included:
Action, Punctuality, Attitude, Management, Commitment To Result, Technical, Trustworthy, Conflict Management, Teamwork, Vision
Sample Result Document:
Sample Results
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 between . The survey will only be available during these dates.
Edit this Survey
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Action

Clear
Strength
Capable
and
Effective
Could
Benefit from
Development
Needs
Significant
Improvement
  1. Uses strategies to stay ahead of potential challenges at work.
  1. Identifies needs and takes steps to address them.
  1. Avoids procrastination.
  1. Takes action when necessary.
  1. Takes proactive steps to address potential issues before they became a problem.
What are your suggestions for how [Participant Name] can make improvements
in Action?

Punctuality

Clear
Strength
Capable
and
Effective
Could
Benefit from
Development
Needs
Significant
Improvement
  1. Invoices clients on a timely basis.
  1. Conducts appointments at scheduled start time.
  1. Responds to requests for information in a timely manner.
  1. Maintains an efficient schedule of activities.
  1. Starts meetings on time.
What are your suggestions for how [Participant Name] can make improvements
in Punctuality?

Attitude

Clear
Strength
Capable
and
Effective
Could
Benefit from
Development
Needs
Significant
Improvement
  1. Shows by their actions that they trust in the positive intentions of others.
  1. Visibly supports and encourages diversity in style and background.
  1. Is gracious and professional in their interactions with others.
  1. Builds open and trusting relationships.
  1. Contributes to a positive work environment.
What are your suggestions for how [Participant Name] can make improvements
in Attitude?

Management

Clear
Strength
Capable
and
Effective
Could
Benefit from
Development
Needs
Significant
Improvement
  1. Sets an example for others to follow
  1. Makes you feel enthusiastic about your work
  1. Takes responsibility for things that go wrong
  1. Is ready to offer help
  1. Keep staff informed about what is happening in the company
What are your suggestions for how [Participant Name] can make improvements
in Management?

Commitment To Result

Clear
Strength
Capable
and
Effective
Could
Benefit from
Development
Needs
Significant
Improvement
  1. Maintains persistence and dedication to achieving results.
  1. Coordinates all department activities into a cohesive team effort.
  1. Willing to do whatever it takes-not afraid to have to put in extra effort.
  1. Creates a sense of urgency among the store team members to complete activities, which drive sales.
  1. Conveys strong sense of own pride in Company to associates by creating a shared vision around sales and customer service.
What are your suggestions for how [Participant Name] can make improvements
in Commitment To Result?

Technical

Clear
Strength
Capable
and
Effective
Could
Benefit from
Development
Needs
Significant
Improvement
  1. Is knowledgeable of procedures or systems necessary for the job.
  1. Willingly shares information and expertise; sought out as resource by others
  1. Seeks information from others as needed.
  1. Demonstrates mastery of the technical competencies required in his/her work.
  1. Keeps current with technical advances within his/her professional discipline; embraces and applies new techniques and practices
What are your suggestions for how [Participant Name] can make improvements
in Technical?

Trustworthy

Clear
Strength
Capable
and
Effective
Could
Benefit from
Development
Needs
Significant
Improvement
  1. Is trustworthy; is someone I can trust.
  1. Builds and maintains the trust of others.
  1. Works in a way that makes others want to work with her/him.
  1. Seeks to mitigate grievances by clarifying intentions and finding suitable remedies.
  1. Takes care to maintain confidential information.
What are your suggestions for how [Participant Name] can make improvements
in Trustworthy?

Conflict Management

Clear
Strength
Capable
and
Effective
Could
Benefit from
Development
Needs
Significant
Improvement
  1. Addresses contentious issues earlier rather than later.
  1. Is open and honest to avoid misunderstandings.
  1. Facilitates dialog between team members.
  1. Persuades others to accept ideas that may be difficult and uncomfortable.
  1. Identifies strategies to prevent the recurrence of issues.
What are your suggestions for how [Participant Name] can make improvements
in Conflict Management?

Teamwork

Clear
Strength
Capable
and
Effective
Could
Benefit from
Development
Needs
Significant
Improvement
  1. Establishes good rapport with team members.
  1. Encourages others to share ideas to develop team cohesion
  1. Listens to the opinions of other team members.
  1. Focuses on understanding the other team member's message.
  1. Coaches team members to work toward a common goal.
What are your suggestions for how [Participant Name] can make improvements
in Teamwork?

Vision

Clear
Strength
Capable
and
Effective
Could
Benefit from
Development
Needs
Significant
Improvement
  1. Motivates employees to align with the department's vision.
  1. Identifies emerging trends and anticipates future market shifts.
  1. Supports a culture of the department that is willing to implement the company's vision.
  1. Diagnoses issues and envisions solutions.
  1. Develops an inspiring and ambitious vision for the organization's future.
What are your suggestions for how [Participant Name] can make improvements
in Vision?


  1. Strengths


  2. Areas for Development


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