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

• Does whatever it takes (within reason) to get the job done.
• Takes responsibility for meeting performance standards.
• Takes the initiative to address problems sooner rather than later.
• Immediately develops alternatives and solutions when presented with a problem or issue.
• Fixes problems when they occur.

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

Continual Learning

• Pursues learning that will enhance job performance.
• Takes the initiative to learn new skills.
• Improves on their skill sets.
• Views setbacks as opportunities to learn from.
• Pursues professional development opportunities when they arise.

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

Cultural Awareness

• Treats others with dignity and respect.
• Respects the views offered by individuals with different cultural backgrounds.
• Seeks to reduce obstacles in communication that might arise from cultural differences.
• Effective in working with individuals with a variety of cultural backgrounds.
• Functions effectively within various cultural contexts.

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

Excellence

• Takes a lot of pride in their work.
• Demonstrates the analytical skills to do their job.
• Can be counted on to add value wherever they are involved.
• Produces high quality work.
• Demonstrates the functional or technical skills necessary to do their job.

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

Trustworthy

• Demonstrates congruence between statements and actions.
• Is trustworthy; is someone I can trust.
• Builds and maintains the trust of others.
• Takes care to maintain confidential information.
• Delivers on promises made.

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.