Action - 360 Degree Feedback Survey Sample #5

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
Is not afraid to take corrective action when necessary.
Displays high energy and enthusiasm on consistent basis.
Drives and mobilizes others progress toward goals.
Does whatever it takes (within reason) to get the job done.
Gets the job done.
Feedback	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Open to the suggestions of others.
Looks to others for input.
Seeks feedback to enhance performance.
Considers other's opinion and suggestions.
Is visible and approachable.
Juggling Multiple Responsibilities	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Plans and organizes continuously while performing all other responsibilities and activities.
Assesses current capabilities before committing to new requests from customers.
Manages impact of increased traffic flow and freight receipt by detailed planning of controllables and by anticipating and reacting positively to uncontrollables.
Observes, analyzes, and responds to merchandise needs while serving customers and accomplishing operational tasks.
Maintains self-confidence and a positive mental attitude while facing challenging peaks and valleys of activities.
Strategic Insight	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Formulates policies and strategies for addressing the Company's important challenges.
Identifies potential problems before they become critical incidents.
Implements long-term solutions to problems.
Maintains knowledge of current trends in the industry.
Formulates strategies and action plans to ensure successful completion of goals and objectives.
Company	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Understands the "basics" as to how [Company] functions/operates.
Attends [Company] gatherings and social events.
Impresses upon others the important aspects of [Company].
Expresses loyalty and dedication to [Company] in interactions with others.
Follows existing procedures and processes.
Vision	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Develops action plans to align his/her work with the goals of the organization
Creates a common vision for others.
Clearly articulates a vision for his/her work and inspires others to support it
Communicates a vision of where the Company needs to be in the future.
Demonstrates consistency between words and actions

31. Overall, please rate the effectiveness of .
    

    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 's assessment.