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)
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.


Action

Clear
Strength
Capable
and
Effective
Could
Benefit from
Development
Needs
Significant
Improvement
  1. Approves purchase requests in a timely manner.
  1. Will take action to address a problem rather than to wait to confer with others about the situation.
  1. Pursues goals with action to achieve success.
  1. Starts immediately working on assignments.
  1. Takes corrective action when necessary.
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. Conducts appointments at scheduled start time.
  1. Avoids making personal phone calls during working hours.
  1. Starts meetings on time.
  1. Maintains an efficient schedule of activities.
  1. Arrives to 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. Treats all people fairly and with respect.
  1. Contributes to a positive work environment.
  1. Contributes to a positive and fun work environment.
  1. Builds open and trusting relationships.
  1. Works to eliminate unnecessary work or barriers that get in others' way.
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. Keep staff informed about what is happening in the company
  1. Makes you feel enthusiastic about your work
  1. Delegate tasks effectively
  1. Takes responsibility for things that go wrong
  1. Is ready to offer help
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. Conveys strong sense of own pride in Company to associates by creating a shared vision around sales and customer service.
  1. Coordinates all department activities into a cohesive team effort.
  1. Takes immediate action toward goals.
  1. Able to focus on a task even when working alone.
  1. Committed to the team.
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. Knows how to produce high quality products/work.
  1. Willingly shares information and expertise; sought out as resource by others
  1. Seeks information from others as needed.
  1. Keeps current with technical advances within his/her professional discipline; embraces and applies new techniques and practices
  1. Is naturally sought out by people outside his/her particular area for advice and opinion on a broad range of matters - not necessarily solely legal advice.
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. Demonstrates a sense of responsibility and commitment to public trust.
  1. Takes ownership, delivers on commitments
  1. Is trustworthy; is someone I can trust.
  1. Is a person you can trust.
  1. Delivers on promises made.
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. Discusses conflict situations with supervisor.
  1. Tries to understand others' point of view before making judgments
  1. Assists team members by helping them see the other point of view.
  1. Helps employees to think through alternative ways to resolve conflict situations.
  1. Deals effectively with employee grievances.
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. Fosters an environment that promotes active listening on the team.
  1. Fosters respect and understanding among team members
  1. Works with other team members on the project.
  1. Takes the time to listen to the team's ideas.
  1. Willingly share their technical expertise
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. Behaves in a way that is consistent with business values & code of conduct
  1. Communicates the vision and strategy of [Company]
  1. Develops action plans to align his/her work with the goals of the organization
  1. Demonstrates consistency between words and actions
  1. Communicates a vision of where the Company needs to be in the 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.