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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 can adjust tactics and strategies.
  1. You adjust plans to meet the needs of new constraints.
  1. You will stop what you are doing to help colleagues in need.
  1. You adapt quickly to new situations.
  1. You continually try to improve skills to remain current.
  1. You are able to respond to incidents without stopping the workflow.
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 address safety issues immediately.
  1. I ensure that the team's tasks align with its overall objectives.
  1. I take action when necessary.
  1. I take on additional responsibilities outside of my job description to help the team succeed.
  1. I stay focused and productive when there is work to be done.
  1. You are driven to complete a high amount of work.
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 analyze own reactions on the spot to ensure that communication does not appear to be driven by anger.
  1. You deal with conflict by controlling own emotions by listening, being flexible, and sincere in responding.
  1. You are aware of personal impact on others and adjusts behavior to create a positive leadership presence.
  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 set an example for associates during stressful periods by maintaining a positive, can-do attitude.
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 continue to ask questions about process and systems to further improve own knowledge.
  1. You are curious about learning new things.
  1. You take charge of your training and skills enhancement.
  1. You take the initiative to learn new skills.
  1. You share best practices with others and learn from others.
  1. You set relevant learning objectives and goals.
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 hold team members accountable to commitments made
  1. You communicate calmly and honestly even when stressed.
  1. You are a highly effective supervisor.
  1. You are a highly effective supervisor.
  1. You are able to organize the work of others.
  1. You coach others and prepares them for current and future business demands.
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. I provide employees with necessary resources to accomplish your goals.
  1. You hold employees accountable for meeting performance expectations.
  1. You review job performance shortly after completion of tasks.
  1. I recognize employees who have courage in persevering against great odds and difficulties.
  1. I participate in training as needed to improve job performance.
  1. You inform the employee of the required sales/production targets.
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 integrate developing others with driving sales, serving customers, merchandising, performing operational procedures, and maintaining an appealing store environment.
  1. You create an effective balance of workload between different projects.
  1. You can easily switch between tasks when a critical incident requires attention.
  1. You switch attention to more urgent tasks when necessary.
  1. You rank the importance of tasks to make sure critical tasks are completed first.
  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 consistently keep commitments.
  1. You deliver on promises made.
  1. You take care to maintain confidential information.
  1. You seek to mitigate grievances by clarifying intentions and finding suitable remedies.
  1. You demonstrate congruence between statements and actions.
  1. You build and maintain the trust of others.
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 provide constructive feedback to others.
  1. You create opportunities for professional development.
  1. You try to ensure employees are ready to move to the next level.
  1. You set performance objectives for subordinates that encourages development opportunities.
  1. You create a work environment that fosters positive feedback to employees.
  1. You are open to receiving feedback.
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. I work well with other team members.
  1. I make decisions that support the team's goals and objectives.
  1. I work with other team members to identify bottle necks in the production process.
  1. I work with other team members on the project.
  1. I am open to alternative ways to accomplish goals suggested by the team.
  1. I am committed to the successful completion of team goals.
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.