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 preemptive actions avoid obstacles or delays.
Addresses performance issues quickly.
Changes course to meet the needs of a new situation.
Is proactive in developing solutions to problems.
Is decisive when making decisions.
Feedback	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Seeks feedback to enhance performance.
Considers other's opinion and suggestions.
Accepts the views of others.
Is easy to approach with ideas and opinions.
Looks to others for input.
Juggling Multiple Responsibilities	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Integrates developing others with driving sales, serving customers, merchandising, performing operational procedures, and maintaining an appealing store environment.
Determines which tasks are critical and which tasks are optional.
Assesses current capabilities before committing to new requests from customers.
Ensures that assignments are prioritized according to the needs of the department/company.
Ranks the importance of tasks to make sure critical tasks are completed first.
Strategic Insight	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Identifies potential problems before they become critical incidents.
Identifies root causes of problems.
Creates strategic plans to develop and promote organizational and area strengths, as well as to address weaknesses based on insight from surveys.
Maintains knowledge of current trends in the industry.
Creates a vision for the organization based on insights gathered from other companies in the industry.
Company	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Understands the "basics" as to how [Company] functions/operates.
Impresses upon others the important aspects of [Company].
Understands the use of [Company] products and services.
Expresses loyalty and dedication to [Company] in interactions with others.
Understands how decisions impact other business units beyond their immediate department of work group.
Vision	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Works to support the strategy of [Company]
Defines a roadmap for realizing the organization's vision.
Stays ahead of the curve and guides the team towards innovative solutions and strategic decisions.
Inspires and motivates employees through an influential vision.
Enables employees to commit to the departmental vision.

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.