Adaptability - 360 Degree Feedback Survey Sample #5

Dear Employee:

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 Closing Comments section. Your responses will be compiled with feedback from others and presented to the recipient to help guide their ongoing development.

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Please ensure that your submission is made by .

Thank you for your participation in the survey.

Management Team

Adaptability	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Recognizes and implements changes to enhance efficiency and effectiveness.
Flexible and open to new ideas and encourages others to value change.
Is proactive and takes steps to prepare for changes in the workplace.
Performs a wide range of tasks, responds to changes in direction and priorities and accepts new challenges, responsibilities, and assignments.
Ability to recognize the potential benefits of change, and create an infrastructure which supports change.
Feedback	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Asks others for their ideas and opinions.
Shares past experiences with others as learning opportunities.
Open to the suggestions of others.
Actively seeks feedback from others.
Seeks feedback to enhance performance.
Time Management	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Deals effectively with interruptions.
Avoids distractions in the workplace.
Sets a good balance between work and family life.
Focuses on tasks that have high priority.
Does not become flustered by deadlines and timelines.
Trustworthy	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Takes care to maintain confidential information.
Is trustworthy; is someone I can trust.
Is a person you can trust.
Builds and maintains the trust of others.
Demonstrates congruence between statements and actions.
Teamwork	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Act as an effective team player
Encourages collaboration with other departments.
Coaches team on how to solve problems, plan, and meet organizational goals and objectives.
Encourages teamwork and collaboration.
Contributes to and supports team decision-making process
Strategic Focus	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Able to decline a poor strategy by proposing alternate strategies.
Creates plans to develop and promote organizational and area strengths, as well as to address weaknesses.
Sustains or achieves a competitive advantage for the organization by analyzing the best practices and lessons learned from other organizations.
Focuses attention on treating the causes of problems rather than simply addressing the symptoms.
Looks for opportunities to enhance contributions to the bottom line.

31. Overall, please rate the effectiveness of .
    

    5- Very Effective 4- Effective 3- Neither 2- Ineffective 1- Very Ineffective

    
    
32. Strengths
    
    
    
33. Areas for Development
    
    
    
34. Please give any final comments or suggestions for 's assessment.