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
Decides to act rather than remain passive.
Makes effective decisions, even when under pressure.
Gets the job done.
Effectively makes decisions
Is proactive in developing solutions to problems.
Feedback	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Shares past experiences with others as learning opportunities.
Accepts the views of others.
Seeks feedback to enhance performance.
Actively seeks feedback from others.
Is visible and approachable.
Juggling Multiple Responsibilities	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Determines which tasks are critical and which tasks are optional.
Can multitask while performing all of their other responsibilities and activities.
Observes, analyzes, and responds to merchandise needs while serving customers and accomplishing operational tasks.
Recognizes and responds to product placement and signing needs while staying alert to customers' needs, store activities and training associates.
Plans and organizes continuously while performing all other responsibilities and activities.
Strategic Insight	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Meets with customers to gain insight into their core needs and how best to serve them.
Communicates with employees to find out their needs.
Adjusts strategic plans based on insights gathered from different points of view.
Converses with customers and clients to get a better insight into their personal needs.
Attends industry conferences to gain further insight into how other companies deal with similar issues.
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.
Understands the use of [Company] products and services.
Understands how decisions impact other business units beyond their immediate department of work group.
Impresses upon others the important aspects of [Company].
Vision	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Persuades others to follow the Company's vision.
Communicates the vision and strategy of [Company]
Works to support the strategy of [Company]
Leads employees in new directions.
Communicates a vision of where the Company needs to be in the future.

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.