Action - 360 Degree Feedback Survey Sample #10

360 Feedback Survey

Instructions

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 comment section for that competency. 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.

Action

• Gets the job done.
• Does whatever it takes (within reason) to get the job done.
• Makes effective decisions, even when under pressure.
• Is not afraid to take corrective action when necessary.
• Drives and mobilizes others progress toward goals.

If [Participant Name] were to make improvements in Action, what are your suggestions for how he/she can improve this?

Continual Learning

• Is open to new ideas and concepts.
• Pursues professional development opportunities when they arise.
• Seeks opportunities to grow in skills and knowledge.
• Participates in regular training offered.
• Views setbacks as opportunities to learn from.

If [Participant Name] were to make improvements in Continual Learning, what are your suggestions for how he/she can improve this?

Cultural Awareness

• Is curious and willing to ask questions about the cultural differences in the workplace.
• Maintains an inclusive work environment that maximizes the talents of others in achieving goals.
• Seeks to reduce obstacles in communication that might arise from cultural differences.
• Helps other employees to become more culturally sensitive.
• May advocate for others with different cultural backgrounds.

If [Participant Name] were to make improvements in Cultural Awareness, what are your suggestions for how he/she can improve this?

Excellence

• Demonstrates the functional or technical skills necessary to do their job.
• Is planful and organized.
• Demonstrates the analytical skills to do their job.
• Can be counted on to add value wherever they are involved.
• Keeps themselves and others focused on constant improvement.

If [Participant Name] were to make improvements in Excellence, what are your suggestions for how he/she can improve this?

Trustworthy

• Takes ownership, delivers on commitments
• Consistently keeps commitments.
• Delivers on promises made.
• Builds and maintains the trust of others.
• Is trustworthy; is someone I can trust.

If [Participant Name] were to make improvements in Trustworthy, what are your suggestions for how he/she can improve this?

Overall, please rate the effectiveness of [Participant Name Here].

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

Strengths


Areas for Development


Please give any final comments or suggestions for [Participant Name Here]'s assessment.