Action - 360 Degree Feedback Survey Sample #11

360 Feedback Survey

Instructions

We appreciate you taking the time to provide valuable feedback for the individual mentioned above. As you respond, please draw on your first-hand experience with this individual in the past 12 months. Your insights are crucial in offering a comprehensive evaluation. Please rate each item using the scale provided. If you find that you do not have sufficient first-hand knowledge to rate a particular item, select the Not Applicable option.

In addition to the ratings, we encourage you to include comments where possible. These comments are particularly useful when you give a very high or very low rating, as they provide context and clarity regarding your assessment. Explaining your reasons in the comment section helps ensure that your feedback is constructive and actionable.

Your responses, combined with feedback from other contributors, will be compiled and presented to the individual. This collective feedback aims to support their continuous growth and development by highlighting strengths and identifying areas for improvement. Your thoughtful participation is essential in helping them achieve their full potential.

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.

To what extent does [Participant Name] exhibit the following ...

SELECT the rating that best reflects the employee's performance in the areas listed.

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Action

What does Action mean?
It means that ...

• I initiate actions to get things done.
• You do whatever it takes (within reason) to get the job done.
• You avoid procrastinating.
• I assign tasks to team members based on their strengths.
• I take on additional responsibilities outside of my job description to help the team succeed.

To what extent does this person exhibit Action?
Select from one of the ratings below.

Not Applicable or Unable to Judge

Poor does not perform to expected standards; often unable to complete tasks; does not seek help or advice

Minimal completes tasks only when pressured to do so; is satisfied with minimal progress; only does what is required

Average completes tasks easily; seeks to obtain maximal performance; willing to seek advice and help when needed

Role Model is a role model for others to follow; goes above and beyond what is expected; helps others

Self Management

What does Self Management mean?
It means that ...

• You do not allow own emotions to interfere with the performance of others.
• You analyze interpersonal problems instead of reacting to them.
• You analyze own reactions on the spot to ensure that communication does not appear to be driven by anger.
• You step away from a situation to process appropriate response.
• You consciously control own negative emotions in order to keep team morale up.

To what extent does this person exhibit Self Management?
Select from one of the ratings below.

Not Applicable or Unable to Judge

Poor does not perform to expected standards; often unable to complete tasks; does not seek help or advice

Minimal completes tasks only when pressured to do so; is satisfied with minimal progress; only does what is required

Average completes tasks easily; seeks to obtain maximal performance; willing to seek advice and help when needed

Role Model is a role model for others to follow; goes above and beyond what is expected; helps others

Performance

What does Performance mean?
It means that ...

• You produce quality
• You set a high standard for job performance.
• You have great overall performance
• You work effectively in the department.
• You are effective in performing your job.

To what extent does this person exhibit Performance?
Select from one of the ratings below.

Not Applicable or Unable to Judge

Poor does not perform to expected standards; often unable to complete tasks; does not seek help or advice

Minimal completes tasks only when pressured to do so; is satisfied with minimal progress; only does what is required

Average completes tasks easily; seeks to obtain maximal performance; willing to seek advice and help when needed

Role Model is a role model for others to follow; goes above and beyond what is expected; helps others

Time Management

What does Time Management mean?
It means that ...

• I respond immediately to requests rather than waiting to respond.
• I emphasize punctuality in the department and make sure employees know they are expected to be on time.
• I arrive to (attend) meetings on time.
• I consistently meet production deadlines.
• You react promptly to inquiries from customers/clients.

To what extent does this person exhibit Time Management?
Select from one of the ratings below.

Not Applicable or Unable to Judge

Poor does not perform to expected standards; often unable to complete tasks; does not seek help or advice

Minimal completes tasks only when pressured to do so; is satisfied with minimal progress; only does what is required

Average completes tasks easily; seeks to obtain maximal performance; willing to seek advice and help when needed

Role Model is a role model for others to follow; goes above and beyond what is expected; helps others

Developing Others

What does Developing Others mean?
It means that ...

• You assign tasks and responsibilities to develop skills of others.
• You create opportunities for professional development.
• You support the successes of other employees.
• You are open to receiving feedback.
• You encourage employees through recognition of positive changes in behavior.

To what extent does this person exhibit Developing Others?
Select from one of the ratings below.

Not Applicable or Unable to Judge

Poor does not perform to expected standards; often unable to complete tasks; does not seek help or advice

Minimal completes tasks only when pressured to do so; is satisfied with minimal progress; only does what is required

Average completes tasks easily; seeks to obtain maximal performance; willing to seek advice and help when needed

Role Model is a role model for others to follow; goes above and beyond what is expected; helps others

Organizational Fluency

What does Organizational Fluency mean?
It means that ...

• You get things done through the department.
• You are aware of other organizational cultures to compare/contrast with the current organizational culture.
• You are able to use corporate politics to advance department objectives.
• You are able to explain departmental policies and procedures to others.
• You understand departmental policies and procedures.

To what extent does this person exhibit Organizational Fluency?
Select from one of the ratings below.

Not Applicable or Unable to Judge

Poor does not perform to expected standards; often unable to complete tasks; does not seek help or advice

Minimal completes tasks only when pressured to do so; is satisfied with minimal progress; only does what is required

Average completes tasks easily; seeks to obtain maximal performance; willing to seek advice and help when needed

Role Model is a role model for others to follow; goes above and beyond what is expected; helps others

Strengths


Areas for Development


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