Action - 360 Degree Feedback Survey Sample #5

360-Degree Assessment Survey

Dear Employee:

Thank you for providing feedback for the recipient above. As you respond, please draw on your first-hand experience with this individual in the past 12 months. Rate each item using the scale shown. If you don't feel you have enough first-hand information to rate a certain item, please choose the Not Applicable option. Comments can be very helpful; at a minimum where you give a particularly high or low rating, please share your reasons in the Closing Comments section. Your responses will be compiled with feedback from others and presented to the recipient to help guide their ongoing 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.

Please ensure that your submission is made by .

Thank you for your participation in the survey.

Management Team

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Action	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Seeks new opportunities for advancement.
Pursues goals with action to achieve success.
Addresses safety issues immediately.
Effectively handles multiple complex issues simultaneously.
Avoids procrastination.
Feedback	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Seeks feedback to enhance performance.
Considers other's opinion and suggestions.
Open to the suggestions of others.
Shares past experiences with others as learning opportunities.
Is visible and approachable.
Juggling Multiple Responsibilities	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Completes multiple tasks simultaneously.
Prioritizes tasks for efficiency.
Integrates developing others with driving sales, serving customers, merchandising, performing operational procedures, and maintaining an appealing store environment.
Builds in extra time in the schedule for unplanned events/occurrences.
Begins tasks as soon as possible.
Strategic Insight	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Communicates with employees to find out their needs.
Converses with customers and clients to get a better insight into their personal needs.
Understands the Company's strengths and weaknesses and uses this information to create optimal solutions to problems.
Maintains knowledge of current trends in the industry.
Observes employees at work to get better insight into the issues they are dealing with.
Company	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Expresses loyalty and dedication to [Company] in interactions with others.
Understands the "basics" as to how [Company] functions/operates.
Impresses upon others the important aspects of [Company].
Follows existing procedures and processes.
Understands how decisions impact other business units beyond their immediate department of work group.
Vision	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Tasks employees with realizing the vision.
Provides vision and strategies to the team.
Develops a vision to empower employees to make more effective decisions.
Detects problems and creates solutions.
Provides staff with the necessary resources, authority, and support to effectively implement and achieve the organization's vision.

31. Overall, please rate the effectiveness of [Participant Name Here].
    

    5- Very Effective 4- Effective 3- Neither 2- Ineffective 1- Very Ineffective

    
    
32. Strengths
    
    
    
33. Areas for Development
    
    
    
34. Please give any final comments or suggestions for [Participant Name Here]'s assessment.