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
Is aware of changes in the environment.
Handles unexpected events without a loss of productivity.
Able to quickly learn new ways of performing their job.
Adjusts priorities to changing business goals.
Able to respond to incidents without stopping the workflow.
Feedback	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Is easy to approach with ideas and opinions.
Actively seeks feedback from others.
Asks others for their ideas and opinions.
Is visible and approachable.
Open to the suggestions of others.
Time Management	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Avoids spending time on non-work related activities.
Delegates routine tasks to team members, allowing the manager to concentrate on more strategic or complex responsibilities.
Sustains high productivity levels throughout the day.
Integrates automation into the process whenever feasible.
Starts projects without delay.
Trustworthy	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Is trustworthy; is someone I can trust.
Demonstrates a sense of responsibility and commitment to public trust.
Builds and maintains the trust of others.
Communicates an understanding of the other person's interests, needs and concerns.
Consistently keeps commitments.
Teamwork	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Builds a strong rapport with team members.
Encourages others to share ideas to develop team cohesion
Treats other team members with respect.
Willingly share their technical expertise
Works with other team members to identify bottle necks in the production process.
Strategic Focus	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Evaluates and reviews the implementation of the strategic plan to ensure achievement of the objectives.
Identifies areas where return on investment can be improved.
Creates deadlines for various components of the strategy.
Develops a strategic plan to focus on strategic issues.
Develops a strategic focus on internal factors to improve efficiency or conserve limited resources.

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.