Action - Pulse Survey - Sample #6

Dear Employee:

You have been selected to provide feedback on the employee listed above. Your feedback is an important part of our company's leadership development process and this survey is intended to gather broad feedback in the core competencies and role responsibilities that are important for the on-going success of our organization.

In responding to the questions below, think about your experiences working with this employee over the last twelve months. The effectiveness of this development tool is dependent on your honest, forthright and constructive responses so please bear this in mind as you answer each question. Your responses will be aggregated with the responses received from others and discussed with the employee to foster growth and on-going development.

We encourage everyone to complete the survey. Please be honest, constructive and thoughtful in your input. The survey is designed to help us understand more about your thoughts and needs to make a great company.

The results of this survey will be used to help drive our future success. We will report back to you about what you have said and what we plan to do about it. If you have any questions about the process please contact [Contact Person].

Please ensure that your submission is made between and . The survey will only be available during these dates.

Thank you for your participation in the survey. We look forward to seeing the analysis of your responses and we are hoping for 100% participation.

Management Team

Action	Needs Significant Improvement	Could benefit from Development	Capable and Effective	Role Model
Effectively makes decisions
Is not afraid to take corrective action when necessary.
Drives and mobilizes others progress toward goals.
Does whatever it takes (within reason) to get the job done.
Gets the job done.
Passion To Learn	Needs Significant Improvement	Could benefit from Development	Capable and Effective	Role Model
Critiques own performance and learns from experience as a source of continuous improvement.
Takes initiative for own learning and development.
Holds self and associates accountable for goal achievement.
Demonstrates through personal behavior the commitment to high standards of performance.
Constantly enhances product knowledge through experimentation and play.
Persuasion and Influence	Needs Significant Improvement	Could benefit from Development	Capable and Effective	Role Model
Develops a good rapport with others.
Has excellent influencing/negotiating skills.
Understanding what others need.
Attempts to persuade others rather than simply control them.
Able to express own goals and needs.
Performance	Needs Significant Improvement	Could benefit from Development	Capable and Effective	Role Model
...Produce Quality
Effectively organizes resources and plans
Effective in performing his/her job.
Able to organize work.
Has great overall performance
Innovation	Needs Significant Improvement	Could benefit from Development	Capable and Effective	Role Model
Challenges current procedures to develop other alternatives.
Builds upon the ideas and solutions of others.
Analyzes current procedures and identifies opportunities for improvement.
Suggests new ideas at meetings.
Offers constructive improvements to existing systems.
Achievement	Needs Significant Improvement	Could benefit from Development	Capable and Effective	Role Model
Follows-up and takes action when goals are not met to ensure better results in the future.
Completes work to a high technical standard
Set high standards in their performance
Makes a plan for getting things done and drives execution of the strategic plan, actively supporting or leading initiatives to closure.
Systematically works to improve the organization
Excellence	Needs Significant Improvement	Could benefit from Development	Capable and Effective	Role Model
Can be counted on to add value wherever they are involved.
Keeps themselves and others focused on constant improvement.
Demonstrates the functional or technical skills necessary to do their job.
Demonstrates the analytical skills to do their job.
Is planful and organized.
Interpersonal Skills	Needs Significant Improvement	Could benefit from Development	Capable and Effective	Role Model
Values the opinions of others.
Anticipates the concerns of other employees.
Effectively manages conflicts by dealing with them directly and immediately
Strives for win/win solutions
Demonstrates willingness to work with others.
Coaching	Needs Significant Improvement	Could benefit from Development	Capable and Effective	Role Model
Helps employees to maintain high personal standards.
Develops the skills and capabilities of others.
Helps employees to understand responsibilities, authority, and expectations.
Coaches employees in how to strengthen knowledge and skills to improve work performance.
Meets regularly with employees to coach them on areas that will enhance their performance
Negotiation	Needs Significant Improvement	Could benefit from Development	Capable and Effective	Role Model
Able to say "no" when it is essential to maintaining quality and high standards.
Able to say "no" when necessary to effectively execute business strategy and meet long-term objectives.
Influences others through rational argument and persuasion.
Resolves difficult negotiations whether it is a contract, sub contract, legal or any other difficult negotiation fairly and reasonably.
Leverages relationships with others to achieve goals.
Planning	Needs Significant Improvement	Could benefit from Development	Capable and Effective	Role Model
Anticipates obstacles and ways to overcome them.
Able to look ahead (beyond the present) when addressing the work/needs of the department.
Works in an organized manner
Able to identify the needs of the department before a major change.
Delegates role to team members to accomplish goals.

56. Overall, please rate the effectiveness of .
    

    5- Very Effective 4- Effective 3- Neither 2- Ineffective 1- Very Ineffective

    
    
57. Describe the greatest strengths of this person with regard to his/her overall effectiveness in performing his/her current responsibilities.
    
    
    
58. Describe the most important things this person could improve upon in order to increase his/her overall effectiveness in performing his/her current responsibilities.
    
    
    
59. Additional comments, if any for 's assessment.