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
Responsive to the needs of others.
Recognizes and implements changes to enhance efficiency and effectiveness.
Is aware of changes to the policies and procedures.
Is flexible and open minded in dealing with others.
Able to step in and help co-workers when needed.
Feedback	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Asks others for their ideas and opinions.
Accepts the views of others.
Is visible and approachable.
Shares past experiences with others as learning opportunities.
Seeks feedback to enhance performance.
Time Management	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Completes tasks ahead of schedule.
Sets clearly defined goals.
Makes time for developing plans and schedules.
Does not become flustered by deadlines and timelines.
Prioritizes new tasks according to their relative importance.
Trustworthy	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Builds and maintains the trust of others.
Is a person you can trust.
Delivers on promises made.
Demonstrates a sense of responsibility and commitment to public trust.
Is trustworthy; is someone I can trust.
Teamwork	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Encourages others to share ideas to develop team cohesion
Act as an effective team player
Creates opportunities to learn with other team members
Willingly share their technical expertise
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.
Looks for opportunities to enhance contributions to the bottom line.
Communicates goals and objectives to employees.
Monitors performance of each market within the Area, utilizing reports to ensure sales growth, cost management, and profitability targets are met.
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.