Action - 360 Degree Feedback Survey Sample #12





360 Feedback Survey

Questionnaires Measuring Action:
Survey 1 (4-point scale; Competency Comments)
Survey 2 (4-point scale; Competency Comments)
Survey 3 (5-point scale; Competency Comments)
Survey 4 (5-point scale; radio buttons)
Survey 5 (4-point scale; words)
Survey 6 (4-point scale; words)
Survey 7 (5-point scale; competency comments; N/A)
Survey 8 (3-point scale; Agree/Disagree words; N/A)
Survey 9 (3-point scale; Strength/Development; N/A)
Survey 10 (Comment boxes only)
Survey 11 (Single rating per competency)
Survey 12 (Slide-bar scale)
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.

Competencies Included:
Action, Professional Development, Decision Making, Interpersonal Skills, Others
Sample Result Document:
Sample Results
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

  • Initiates actions to get things done.
  • Starts immediately working on assignments.
  • Takes the initiative and does not wait for the situation to change.
  • Does not procrastinate when there is a job to be done.
  • Works at a quick pace.
Needs
Improvement		 Fully
Proficient		 Excels/
Role Model






Click this box to make your rating
Comments:

Professional Development

  • Encourages employees to take courses relevant to their job.
  • Seeks opportunities for professional development.
  • Keep themselves up-to-date of technical/professional issues
  • Seeks opportunities for continuous learning.
  • Contributing fully to the extent of their skills
Needs
Improvement		 Fully
Proficient		 Excels/
Role Model






Click this box to make your rating
Comments:

Decision Making

  • Is creative about the decisions they make.
  • Makes decisions that support the department's goals and objectives.
  • Examines for patterns in data to help predict future possibilities.
  • Evaluates information before making a final decision.
  • Open to the suggestions from subordinates.
Needs
Improvement		 Fully
Proficient		 Excels/
Role Model






Click this box to make your rating
Comments:

Interpersonal Skills

  • Is a committed and reliable partner.
  • Gives good advice and suggestions to coworkers.
  • Provides constructive feedback in a way that fosters acceptance and development.
  • Demonstrates compassion and understanding of others.
  • Is honest about making mistakes and willing to fix them.
Needs
Improvement		 Fully
Proficient		 Excels/
Role Model






Click this box to make your rating
Comments:

Others

  • Is able to see issues from others' perspectives.
  • Constructively receives criticism and suggestions from others.
  • Works across boundaries within the organization.
  • Able to see issues from others' perspectives.
  • Supports the efforts of other employees in implementing solutions to problems.
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.