Action - 360 Degree Feedback Survey Sample #12

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.

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

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

Action

• Effectively makes decisions
• Gets the job done.
• Is not afraid to take corrective action when necessary.
• Makes effective decisions, even when under pressure.
• Motivates & supports others to gain skills

Needs Improvement		Fully Proficient		Excels/ Role Model
Click this box to make your rating

Comments:

Professional Development

• Quickly acquire and apply new knowledge and skills when needed
• Demonstrate enthusiasm and a willingness to learn new skills and knowledge
• Keep themselves up-to-date of technical/professional issues
• Seeks opportunities for continuous learning.
• Seeks opportunities for professional development.

Needs Improvement		Fully Proficient		Excels/ Role Model
Click this box to make your rating

Comments:

Decision Making

• Formulates imaginative decisions.
• Defines parameters that will impact the decision making process.
• Has a good rapport other people which is helpful in making decisions on the team.
• Facilitates meetings with others to try to consider alternative courses of action.
• Performs a cost/benefit analysis before making a decision.

Needs Improvement		Fully Proficient		Excels/ Role Model
Click this box to make your rating

Comments:

Interpersonal Skills

• Provides constructive feedback in a way that fosters acceptance and development.
• Expresses appreciation of other's work.
• Strives for win/win solutions
• Values the opinions of others.
• Demonstrates willingness to work with others.

Needs Improvement		Fully Proficient		Excels/ Role Model
Click this box to make your rating

Comments:

Others

• Is able to see issues from others' perspectives.
• Able to see issues from others' perspectives.
• ...treats others with respect and dignity.
• Supports the efforts of other employees in implementing solutions to problems.
• Includes others in the decision making processes.

Needs Improvement		Fully Proficient		Excels/ Role Model
Click this box to make your rating

Comments:

Strengths


Areas for Development


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