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

• Effectively makes decisions
• Does whatever it takes (within reason) to get the job done.
• Drives and mobilizes others progress toward goals.
• Works quickly when faced with difficult problems.
• Is not afraid to take corrective action when necessary.

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

Continual Learning

• Takes charge of their training and skills enhancement.
• Sets relevant learning objectives and goals.
• Grasps new ideas, concepts, technical, or business knowledge.
• Participates in regular training offered.
• 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

• Values the opinions of diverse groups and individual.
• Shows respect in daily interactions
• Fosters a diverse workforce free from discrimination and harassment.
• Recognizes and values individual and cultural differences.
• Seeks out different viewpoints and benefits from different perspectives.

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

Excellence

• Demonstrates the analytical skills to do their job.
• Produces high quality work.
• Is planful and organized.
• Keeps themselves and others focused on constant improvement.
• Takes a lot of pride in their work.

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

Trustworthy

• Demonstrates a sense of responsibility and commitment to public trust.
• Delivers on promises made.
• Is trustworthy; is someone I can trust.
• Builds and maintains the trust of others.
• Takes care to maintain confidential information.

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.