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

Action	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Displays high energy and enthusiasm on consistent basis.
Works quickly when faced with difficult problems.
Gets the job done.
Makes effective decisions, even when under pressure.
Drives and mobilizes others progress toward goals.
Feedback	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Asks others for their ideas and opinions.
Shares past experiences with others as learning opportunities.
Looks to others for input.
Is visible and approachable.
Seeks feedback to enhance performance.
Juggling Multiple Responsibilities	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Plans and organizes continuously while performing all other responsibilities and activities.
Determines which tasks are critical and which tasks are optional.
Avoids bottlenecks in progress by assigning multiple individuals to critical tasks.
Is aware of the deadlines for specific tasks/assignments.
Assesses current capabilities before committing to new requests from customers.
Strategic Insight	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Communicates vision for the department and company.
Formulates policies and strategies for addressing the Company's important challenges.
Formulates strategies and action plans to ensure successful completion of goals and objectives.
Creates strategies that significantly benefit the Company.
Analyzes records and reports to obtain insight into potential issues and trends.
Company	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Understands the "basics" as to how [Company] functions/operates.
Understands the use of [Company] products and services.
Follows existing procedures and processes.
Attends [Company] gatherings and social events.
Understands how decisions impact other business units beyond their immediate department of work group.
Vision	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Demonstrates consistency between words and actions
Leads employees in new directions.
Understands the vision of the Company and promotes it ahead of any self-interests.
Expresses the Company vision in a way that is easily understood and adopted by employees.
Creates a positive vision of the future for the Company.

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.