Adaptability - 360 Degree Feedback Survey Sample #14

360 Feedback Survey

Instructions

We are requesting your participation in a 360-degree feedback review of several participants in our company's Leadership Development program. We are administering a new web-based survey tool which is designed to gather broad feedback as it relates to core competencies and role responsibilities that are important for the on-going success of our organization. The Leadership Team Members have agreed to participate and are seeking your feedback.

In this regard, you have been selected to provide feedback for the manager listed above. Your feedback is an important part of this manager's leadership development process. This tool is intended to gather broad feedback in the core competencies and role responsibilities that are important for the on-going success of our organization.

You will get the chance to evaluate this manager's performance in different areas and share your thoughts through written comments for more detailed feedback. Ensure that your feedback is constructive and helpful.

In responding to the assessment form, please think about your experiences working with this individual during the last twelve (12) months. Your responses will be merged with other people's feedback and presented to guide them in their on-going development. Comments will be shared anonymously, as written, with the manager, unless you indicate otherwise.

You are only being asked to rate 8 competencies. Each competency will have a variety of statements that are grouped by 4 Performance Levels. Click on the level that best describes this individual.

Please ensure that your submission is made between .

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Adaptability	Needs Improvement	Could Benefit from Development	Performs as Expected	Is a Role Model for Others	Don't Know
Will stop what they are doing to help colleagues in need.
Works effectively in dynamic and changing work environments.
Adjusts strategy when new information is presented.
Responsive to the needs of others.
Easily accepts new responsibilities.
Adjusts priorities to the new Corporate mission.
Effective in working with different personnel of the team.
Adjusts to new plans and procedures.
Performs a wide range of tasks, responds to changes in direction and priorities and accepts new challenges, responsibilities, and assignments.
If [Participant Name] were to make improvements in Adaptability, what are your suggestions for how he/she can improve this?
Integrity	Needs Improvement	Could Benefit from Development	Performs as Expected	Is a Role Model for Others	Don't Know
Follows tasks to completion.
Establishes relationships of trust, honesty, fairness, and integrity.
Maintains strong relationships with others.
Develops trust and confidence from others.
Does what was promised.
Accepts responsibility for mistakes.
Demonstrates sincerity in actions with others.
Fosters an environment built upon trust.
Fosters a high standard of ethics and integrity.
If [Participant Name] were to make improvements in Integrity, what are your suggestions for how he/she can improve this?
Cultural Awareness	Needs Improvement	Could Benefit from Development	Performs as Expected	Is a Role Model for Others	Don't Know
Functions effectively within various cultural contexts.
Communicates with others without the influence of racism.
Accepts individual differences.
Recognizes individual and cultural differences.
Effective in working with individuals with a variety of cultural backgrounds.
Treats others with dignity and respect.
Seeks knowledge and information about other cultures.
Open to learning about different cultures.
Aware of their own cultural views.
If [Participant Name] were to make improvements in Cultural Awareness, what are your suggestions for how he/she can improve this?
Communication Skills	Needs Improvement	Could Benefit from Development	Performs as Expected	Is a Role Model for Others	Don't Know
Willing to communicate issues and concerns to colleagues.
Accurately attends to/understands ideas which are exchanged.
Asks follow-up questions as needed.
Responds in a timely manner, respecting deadlines and others' schedules.
Communicates concepts and ideas to others.
Updates others on changes or progress in plans and goals.
Uses polite language and shows respect for others' opinions and time.
Able to communicate ideas effectively and succinctly to both individuals and groups, in any setting.
Clarifies problems logically, simplifying complex matters into digestible parts.
If [Participant Name] were to make improvements in Communication Skills, what are your suggestions for how he/she can improve this?
Administrative Skill	Needs Improvement	Could Benefit from Development	Performs as Expected	Is a Role Model for Others	Don't Know
Able to develop, justify and present a budget.
Has strong technical/computer skills.
Strong organizational skills to keep the workspace and department in order
Takes responsibility for decisions.
Accurately implements contract provisions.
Completes reports on-time.
Implements and uses performance measures.
High attention to detail.
Enthusiastic about taking on challenging projects.
If [Participant Name] were to make improvements in Administrative Skill, what are your suggestions for how he/she can improve this?
Results Oriented	Needs Improvement	Could Benefit from Development	Performs as Expected	Is a Role Model for Others	Don't Know
Ensures the team understands the objective that needs to be completed.
Does not become distracted by non-issues or interruptions.
Is a high achiever.
Demonstrates the personal confidence to "stay the course," even when faced with difficulty
Encourages employees to give 100% to achieving high results.
Willing to take on new assignments to help increase production.
Prioritizes goals to complete those in urgent need first.
Works toward achievement of goals even when confronted with obstacles.
Creates measures of performance to track progress.
If [Participant Name] were to make improvements in Results Oriented, what are your suggestions for how he/she can improve this?
Responsible	Needs Improvement	Could Benefit from Development	Performs as Expected	Is a Role Model for Others	Don't Know
Holds herself / himself accountable to goals / objectives
Responsible for setting the vision of the department.
...takes personal responsibility for results.
Works in a way that makes others want to work with her/him.
Sets a good example
Is a person you can trust.
Behavior is ethical and honest.
Sets a good example.
Acts as a resource without removing individual responsibility.
If [Participant Name] were to make improvements in Responsible, what are your suggestions for how he/she can improve this?

64. Strengths
    
    
    
65. Areas for Development
    
    
    
66. Please give any final comments or suggestions for [Participant Name Here]'s assessment.