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
Makes effective decisions, even when under pressure.
Motivates & supports others to gain skills
Effectively makes decisions
Is not afraid to take corrective action when necessary.
Does whatever it takes (within reason) to get the job done.
Feedback	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Open to the suggestions of others.
Is visible and approachable.
Asks others for their ideas and opinions.
Actively seeks feedback from others.
Considers other's opinion and suggestions.
Juggling Multiple Responsibilities	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Uses a scheduler/planner to keep tasks organized and on time.
Ensures that assignments are prioritized according to the needs of the department/company.
Integrates developing others with driving sales, serving customers, merchandising, performing operational procedures, and maintaining an appealing store environment.
Recognizes and responds to product placement and signing needs while staying alert to customers' needs, store activities and training associates.
Avoids bottlenecks in progress by assigning multiple individuals to critical tasks.
Strategic Insight	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Identifies potential problems before they become critical incidents.
Communicates vision for the department and company.
Formulates policies and strategies for addressing the Company's important challenges.
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.
Company	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Attends [Company] gatherings and social events.
Follows existing procedures and processes.
Understands the use of [Company] products and services.
Understands how decisions impact other business units beyond their immediate department of work group.
Understands the "basics" as to how [Company] functions/operates.
Vision	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Works to support the strategy of [Company]
Creates a positive vision of the future for the Company.
Clearly articulates a vision for his/her work and inspires others to support it
Persuades others to follow the Company's vision.
Expresses the Company vision in a way that is easily understood and adopted by employees.

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.