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
Takes advantage of changes to the current situation.
Is proactive in developing solutions to problems.
Is not afraid to take corrective action when necessary.
Overcomes obstacles that may impede progress on a task.
Gets the job done.
Feedback	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Is easy to approach with ideas and opinions.
Considers other's opinion and suggestions.
Actively seeks feedback from others.
Open to the suggestions of others.
Seeks feedback to enhance performance.
Juggling Multiple Responsibilities	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Organizes tasks for the most efficient order of completion.
Plans and organizes continuously while performing all other responsibilities and activities.
Assesses current capabilities before committing to new requests from customers.
Can multitask while performing all of their other responsibilities and activities.
Coordinates the work of a team by assigning tasks to other team members.
Strategic Insight	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Observes employees at work to get better insight into the issues they are dealing with.
Creates a mission statement describing the purpose for the organization.
Creates strategies that significantly benefit the Company.
Converses with customers and clients to get a better insight into their personal needs.
Develops a plan and strategy for each functional area within the mission statement.
Company	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Attends [Company] gatherings and social events.
Impresses upon others the important aspects of [Company].
Follows existing procedures and processes.
Understands the "basics" as to how [Company] functions/operates.
Understands the use of [Company] products and services.
Vision	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Focuses efforts on implementing the organization's strategic vision.
Analyzes data and industry patterns to forecast opportunities and challenges.
Develops strategies that align with the organization's collective vision.
Assigns the responsibility of implementing the vision to the team, ensuring they have clear guidance, adequate resources, and the necessary authority.
Envisions and articulates a clear path for the department's growth over the next year.

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.