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Adaptability - 360 Degree Feedback Survey Sample #1





360-Degree Feedback Survey

Questionnaires Measuring Adaptability:
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)
Survey 13 (4-point scale; numbers; floating anchors)
Survey 14 (4-point scale; N/A)
Instructions for Employees Participating in the 360-Feedback Assessment:

[Company] is conducting a 360-Degree Feedback Assessment developed by HR-Survey for selected managers.

You have been selected to receive feedback from a group of others. As part of this process, you will need to complete a self-assessment questionnaire at this time. Your feedback is an important part of our company's leadership development process and this survey is intended to gather broad feedback in the core competencies and role responsibilities that are important for the on-going success of our organization.

In responding to the questions below, think about your experiences over the last 12 months. The effectiveness of this development tool is dependent on your honest, forthright and constructive responses so please bear this in mind as you answer each question. Your responses will be combined with the responses received from others and a report will be generated for you to foster growth and on-going 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.

Competencies Included:
Adaptability, Action, Self Management, Continual Learning, Leadership, Managing Performance, Juggling Multiple Responsibilities, Trustworthy, Developing Others, Teamwork
Sample Result Document:
Sample Results
Your feedback is valuable in helping the individual to understand how they are perceived and experienced by others and the impact their behavior has on people in the organization with whom they interact. Feedback received also acknowledges strengths and identifies areas for development.

Use the form below to provide your feedback. Each field and comment box requires a response before you can SUBMIT your final feedback.

Please ensure that your submission is made between . The survey will only be available during these dates.

Thank you for your participation in the survey. We look forward to seeing the analysis of your responses and we are hoping for 100% participation.

Management Team
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Adaptability

Needs
Improvement
Meets
Minimum
Standards
Is
Proficient
Role
Model
  1. You are responsive to the needs of others.
  1. You analyze situations quickly to determine most pressing needs and possible solutions.
  1. You are aware of changes to the policies and procedures.
  1. You adapt to changes in team membership.
  1. I successfully handle the implementation of the reorganization.
  1. You can adjust plans as needed based on changing conditions.
If you were to make improvements in Adaptability, what are your suggestions for how you can improve this?

Action

Needs
Improvement
Meets
Minimum
Standards
Is
Proficient
Role
Model
  1. You motivate & supports others to gain skills
  1. I prevent small issues from becoming critical incidents.
  1. You are driven to complete a high amount of work.
  1. You display high energy and enthusiasm on consistent basis.
  1. I take responsibility for meeting performance standards.
  1. You identify opportunities for improvement before there is a problem.
If you were to make improvements in Action, what are your suggestions for how you can improve this?

Self Management

Needs
Improvement
Meets
Minimum
Standards
Is
Proficient
Role
Model
  1. You consciously control own negative emotions in order to keep team morale up.
  1. You deal with conflict by controlling own emotions by listening, being flexible, and sincere in responding.
  1. You use patience and self-control in working with customers and associates.
  1. You do not allow own emotions to interfere with the performance of others.
  1. You step away from a situation to process appropriate response.
  1. You analyze own reactions on the spot to ensure that communication does not appear to be driven by anger.
If you were to make improvements in Self Management, what are your suggestions for how you can improve this?

Continual Learning

Needs
Improvement
Meets
Minimum
Standards
Is
Proficient
Role
Model
  1. You take charge of your training and skills enhancement.
  1. You expand your educational and future learning opportunities.
  1. You seek opportunities to grow in skills and knowledge.
  1. You are introspective and aware of your own learning needs.
  1. You build on your strengths while addressing your weaknesses.
  1. You pursue professional development opportunities when they arise.
If you were to make improvements in Continual Learning, what are your suggestions for how you can improve this?

Leadership

Needs
Improvement
Meets
Minimum
Standards
Is
Proficient
Role
Model
  1. You guide decision-making by coaching, counseling and rewarding.
  1. You enhance the quality and productivity of the team.
  1. You inspire a shared culture by keeping employees informed and working together.
  1. You encourage peer-to-peer feedback and open communication across the team.
  1. You maximize the efforts of all team members.
  1. You give feedback promptly so employees can act on it while the situation is still fresh.
If you were to make improvements in Leadership, what are your suggestions for how you can improve this?

Managing Performance

Needs
Improvement
Meets
Minimum
Standards
Is
Proficient
Role
Model
  1. You recommend employees for distinguished service awards if warranted.
  1. I make sure employees understand what is expected of them.
  1. I set and maintain high standards for myself and others.
  1. I measure job performance of subordinates against defined goals and objectives.
  1. You ensure the eligibility of the proposed award recipient.
  1. I implement remediation plans as needed.
If you were to make improvements in Managing Performance, what are your suggestions for how you can improve this?

Juggling Multiple Responsibilities

Needs
Improvement
Meets
Minimum
Standards
Is
Proficient
Role
Model
  1. You can multitask while performing all of your other responsibilities and activities.
  1. You ensure that assignments are prioritized according to the needs of the department/company.
  1. You avoid bottlenecks in progress by assigning multiple individuals to critical tasks.
  1. You bounce back from daily crisis, disappointments and frustrations.
  1. You organize tasks for the most efficient order of completion.
  1. You assess current capabilities before committing to new requests from customers.
If you were to make improvements in Juggling Multiple Responsibilities, what are your suggestions for how you can improve this?

Trustworthy

Needs
Improvement
Meets
Minimum
Standards
Is
Proficient
Role
Model
  1. You are trustworthy; is someone that can be trusted.
  1. You take care to maintain confidential information.
  1. You seek to mitigate grievances by clarifying intentions and finding suitable remedies.
  1. You deliver on promises made.
  1. You take ownership, deliver on commitments
  1. You communicate an understanding of the other person's interests, needs and concerns.
If you were to make improvements in Trustworthy, what are your suggestions for how you can improve this?

Developing Others

Needs
Improvement
Meets
Minimum
Standards
Is
Proficient
Role
Model
  1. You are open to receiving feedback.
  1. You assign tasks and responsibilities to develop skills of others.
  1. You support the successes of other employees.
  1. You recognize and celebrates accomplishments of others.
  1. You assess employees' developmental needs.
  1. You create a work environment that fosters positive feedback to employees.
If you were to make improvements in Developing Others, what are your suggestions for how you can improve this?

Teamwork

Needs
Improvement
Meets
Minimum
Standards
Is
Proficient
Role
Model
  1. You provide assistance and support to other team members when needed
  1. I treat other team members with respect.
  1. You foster an environment that promotes active listening on the team.
  1. You take the time to actively listen to other team member's perspectives.
  1. I am open to alternative ways to accomplish goals suggested by the team.
  1. You willingly share your technical expertise
If you were to make improvements in Teamwork, what are your suggestions for how you can improve this?

  1. What are [Participant Name Here]'s greatest strengths demonstrated this year?


  2. What are [Participant Name Here]'s areas for development?


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