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. Will take action to address a problem rather than to wait to confer with others about the situation.
  1. Takes responsibility for meeting performance standards.
  1. Completes tasks on time in spite of delays in the process.
  1. Persists in work despite obstacles encountered.
  1. Takes advantage of changes to the current situation.
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. Arrives to meetings on time.
  1. Responds to requests for information in a timely manner.
  1. Conducts appointments at scheduled start time.
  1. Invoices clients on a timely basis.
  1. Starts the workday when scheduled.
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. Builds open and trusting relationships.
  1. Contributes to a positive work environment.
  1. Visibly supports and encourages diversity in style and background.
  1. Works to eliminate unnecessary work or barriers that get in others' way.
  1. Is gracious and professional in their interactions with others.
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. Delegate tasks effectively
  1. Keep staff informed about what is happening in the company
  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. Takes immediate action toward goals.
  1. Maintains persistence and dedication to achieving results.
  1. Able to focus on a task even when working alone.
  1. Coordinates all department activities into a cohesive team effort.
  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. Keeps current with technical advances within his/her professional discipline; embraces and applies new techniques and practices
  1. Seeks information from others as needed.
  1. Knows how to produce high quality products/work.
  1. Willingly shares his/her technical expertise; sought out as resource by others
  1. Uses expertise to identify issues and think through creative solutions to get a problem solved or objective accomplished.
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 congruence between statements and actions.
  1. Demonstrates a sense of responsibility and commitment to public trust.
  1. Is a person you can trust.
  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.
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. Encourages team members to express their ideas and concerns openly.
  1. Seeks to remove misperceptions that may contribute toward conflict.
  1. Explores the feasibility of alternative solutions to resolve conflicts.
  1. Deals effectively with employee grievances.
  1. Promotes employee engagement to reduce tensions and negativity, creating an environment where conflicts are easily managed.
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. Coaches team on how to solve problems, plan, and meet organizational goals and objectives.
  1. Creates a climate that encourages team participation.
  1. Carries his/her share of the workload
  1. Actively participates as a team member
  1. Builds relationships across boundaries and with key stakeholders by developing informal and formal networks.
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. Shapes the department's vision into actionable goals.
  1. Inspires and motivates employees through an influential vision.
  1. Engages with key stakeholders to gather insights and ensure alignment with the organization's mission and vision.
  1. Creates a vision that adds value to the organization.
  1. Creates and executes a strategic vision that drives the company's growth forward.
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.