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 flexible and open minded in dealing with others.
Adapts to new environments.
Adjusts to the new vision and mission of the company.
Adjusts plans to meet the needs of new constraints.
Able to adapt to changes in technology and processes.
Feedback	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Seeks feedback to enhance performance.
Open to the suggestions of others.
Is visible and approachable.
Looks to others for input.
Shares past experiences with others as learning opportunities.
Time Management	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Maintains precise time logs for billing.
Makes time for developing plans and schedules.
Sets goals to complete specific parts of the project by certain times to keep on schedule.
Efficiently completes tasks.
Avoids distractions in the workplace.
Trustworthy	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Builds and maintains the trust of others.
Demonstrates a sense of responsibility and commitment to public trust.
Is a person you can trust.
Works in a way that makes others want to work with her/him.
Consistently keeps commitments.
Teamwork	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Fosters an environment that promotes active listening on the team.
Coaches team members
Asks other team members to share their opinions.
Relates to all kinds of people tactfully
Communicates well with team members.
Strategic Focus	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Creates a mission statement describing the purpose for the organization.
Aligns projects to the strategic goals of the company.
Able to formulate strategy at the corporate level.
Successfully implements a strategic plan.
Analyzes the environment to develop strategies to achieve competitive advantage in the marketplace.

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.