Adaptability - 360 Degree Feedback Survey Sample #5

360-Degree Assessment Survey

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.

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.

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
Adjusts priorities to changing business goals.
Works effectively in dynamic and changing work environments.
Flexible and open to new ideas and encourages others to value change.
Learns from personal experiences and/or mistakes.
Is proactive and takes steps to prepare for changes in the workplace.
Feedback	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Accepts the views of others.
Actively seeks feedback from others.
Open to the suggestions of others.
Looks to others for input.
Is visible and approachable.
Time Management	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Prioritizes tasks to identify immediate and long-term objectives.
Uses agendas when chairing or facilitating meetings.
Prioritizes new tasks according to their relative importance.
Completes high-priority work within required timelines.
Makes time for developing plans and schedules.
Trustworthy	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Seeks to mitigate grievances by clarifying intentions and finding suitable remedies.
Builds and maintains the trust of others.
Communicates an understanding of the other person's interests, needs and concerns.
Is a person you can trust.
Takes ownership, delivers on commitments
Teamwork	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Contributes to and supports team decision-making process
Actively participates as a team member
Fosters teamwork rather than individual competition
Comes across as a reliable, committed team member
Relates to all kinds of people tactfully
Strategic Focus	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Understands & contributes to development of strategic goals.
Sustains or achieves a competitive advantage for the organization by analyzing the best practices and lessons learned from other organizations.
Communicates goals and objectives to employees.
Creates plans to develop and promote organizational and area strengths, as well as to address weaknesses.
Understands their role within the organization.

31. Overall, please rate the effectiveness of [Participant Name Here].
    

    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 [Participant Name Here]'s assessment.