Adaptability - 360 Degree Feedback Survey Sample #6

360-Degree Assessment Survey

Dear Employee:

You have been selected to provide feedback on the employee listed above. Your feedback is an important part of our company's leadership development process and this survey is intended to gather broad feedback in the core competencies and role responsibilities that are important for the on-going success of our organization.

In responding to the questions below, think about your experiences working with this employee over the last twelve months. The effectiveness of this development tool is dependent on your honest, forthright and constructive responses so please bear this in mind as you answer each question. Your responses will be aggregated with the responses received from others and discussed with the employee to foster growth and on-going development.

We encourage everyone to complete the survey. Please be honest, constructive and thoughtful in your input. The survey is designed to help us understand more about your thoughts and needs to make this a great company.

The results of this survey will be used to help drive our future success. We will report back to you about what you have said and what we plan to do about it. If you have any questions about the process please contact [Contact Person].

Please ensure that your submission is made between . The survey will only be available during these dates.

Thank you for your participation in the survey. We look forward to seeing the analysis of your responses and we are hoping for 100% participation.

Management Team

Adaptability	Needs Significant Improvement	Could benefit from Development	Capable and Effective	Role Model
Able to quickly learn new ways of performing their job.
Adjusts to the new vision and mission of the company.
Ability to recognize the potential benefits of change, and create an infrastructure which supports change.
Adjusts plans and procedures.
Able to adjust to changes as needed.
Self Management	Needs Significant Improvement	Could benefit from Development	Capable and Effective	Role Model
Analyzes interpersonal problems instead of reacting to them.
Deals with conflict by controlling own emotions by listening, being flexible, and sincere in responding.
Steps away from a situation to process appropriate response.
Is aware of personal impact on others and adjusts behavior to create a positive leadership presence.
Sets an example for associates during stressful periods by maintaining a positive, can-do attitude.
Passion To Learn	Needs Significant Improvement	Could benefit from Development	Capable and Effective	Role Model
Enhances value to the company through additional training and development.
Is open minded and curious about learning new skills.
Takes advantage of training opportunities when they arise.
Creates an environment that supports personal development and exploration.
Takes initiative for own learning and development.
Persuasion and Influence	Needs Significant Improvement	Could benefit from Development	Capable and Effective	Role Model
Persuades others to consider alternative points of view.
Seeks to obtain consensus or compromise.
Communicates effectively with others.
Has excellent influencing/negotiating skills.
Ensures stakeholders are involved in the decision making process.
Achievement	Needs Significant Improvement	Could benefit from Development	Capable and Effective	Role Model
Is results oriented.
Met required benchmarks for the position.
Reduces staff turnover.
Completed training on the new equipment.
Successfully completed the orientation training program.
Managing Risk	Needs Significant Improvement	Could benefit from Development	Capable and Effective	Role Model
Maintains open communication with other departments.
Avoids maintaining the status quo (or standard operating procedures) when addressing new and influential situations.
Accurately determines appropriate risk levels (i.e., levels of acceptable risk).
Seeks to increase safety in the workplace.
Knows how to obtain desired results with minimal losses.
Interpersonal Skills	Needs Significant Improvement	Could benefit from Development	Capable and Effective	Role Model
Creates an atmosphere that supports the open expression of ideas
Assists employees that need help.
Effectively manages conflicts by dealing with them directly and immediately
Creates diverse teams of individuals with different backgrounds, skills, and abilities.
Attends to both the content and the context of what was being said.
Client Focus	Needs Significant Improvement	Could benefit from Development	Capable and Effective	Role Model
Makes sure their interests are aligned with the client's interests.
Provides a high level of service to clients.
Provides a responsive service that meets the needs of clients.
Accepts responsibility for ensuring client satisfaction.
Is aware of the client's needs.
Empowering Others	Needs Significant Improvement	Could benefit from Development	Capable and Effective	Role Model
Creates a culture where employees are given the opportunity to take the initiative and make impactful decisions.
Ensures employees understand what is being assigned to them.
Recognizes the expertise that employees have in certain areas and allows them the freedom to operate as they see fit.
Encourages employees to expand their skills in order to take on greater responsibilities.
Allows for flexibility in the working hours.
Planning	Needs Significant Improvement	Could benefit from Development	Capable and Effective	Role Model
Determines what supplies/equipment will be needed for the project.
Accomplishes major tasks by breaking them into manageable pieces.
Creates plans to handle complex, multi-faceted projects.
Anticipates the impacts of strategic plans.
Able to develop logistics plans to move material through a multi-step supply chain.

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

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

    
    
52. Describe the greatest strengths of this person with regard to his/her overall effectiveness in performing his/her current responsibilities.
    
    
    
53. Describe the most important things this person could improve upon in order to increase his/her overall effectiveness in performing his/her current responsibilities.
    
    
    
54. Additional comments, if any for [Participant Name Here]'s assessment.