Attitude - 360 Degree Feedback Survey Sample #5

360-Degree Assessment Survey

Dear Employee:

Thank you for participating in a 360-degree feedback assessment. In this process, you will complete a self-assessment questionnaire (below). You will also receive feedback from others including your manager, peers and direct reports. As you respond, please respond using just your experiences in the past 12 months. Rate each item using the scale shown. 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 you at the conclusion of this assessment to help guide your ongoing professional 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

Attitude	Role Model	Capable and Effective	Somewhat Effective	Needs Development
You build open and trusting relationships.
You work to eliminate unnecessary work or barriers that get in others' way.
You are gracious and professional in your interactions with others.
You visibly support and encourages diversity in style and background.
You show by your actions that you trust in the positive intentions of others.
Problem Solving	Role Model	Capable and Effective	Somewhat Effective	Needs Development
You are effective in solving problems.
You are a good problem solver and decision maker
You can develop innovative solutions to problems.
You make judgments based upon relevant information.
You identify and assess all potential responses to a problem.
Technical	Role Model	Capable and Effective	Somewhat Effective	Needs Development
You seek information from others as needed.
You willingly share your technical expertise; sought out as resource by others
You keep current with technical advances within your professional discipline; embrace and apply new techniques and practices
You demonstrate mastery of the technical competencies required in your work.
You are knowledgeable of procedures or systems necessary for the job.
Safety	Role Model	Capable and Effective	Somewhat Effective	Needs Development
You develop safety guidelines for the department.
You develop a strong safety culture.
You commit adequate resources toward safety measures.
You work to implement corrective safety measures.
You are not afraid to question a potential safety issue observed in the workplace.
Responsible	Role Model	Capable and Effective	Somewhat Effective	Needs Development
You set high personal standards of performance.
You take personal responsibility for results.
You set a good example
You hold yourself accountable to goals / objectives
You set a good example.
Teamwork	Role Model	Capable and Effective	Somewhat Effective	Needs Development
You encourage teamwork and collaboration.
You create a climate that encourages team participation.
I listen and am attentive to other team members.
You apply knowledge of team behavior to help achieve organizational goals and objectives.
I facilitate effective decision-making practices to further develop the team.
Recognition	Role Model	Capable and Effective	Somewhat Effective	Needs Development
You offer recognition in a timely manner.
You let employees know when they have done well
You compliment other people when they do good work
You make people around them feel appreciated and valued.
You reinforce and reward employees for accomplishing necessary goals.
Fiscal Management	Role Model	Capable and Effective	Somewhat Effective	Needs Development
You ensure others follow the correct rules and regulations on fiscal matters.
You are effective in using company's resources.
You provide budgeting and accounting support to the Company.
You effectively manage appropriations, reporting, purchases, expenditures, payrolls, and staff.
You develop of the department's annual budget.
Planning	Role Model	Capable and Effective	Somewhat Effective	Needs Development
You create to-do lists to make sure nothing is missed.
I can develop plans to ensure the smooth operation of the supply chain.
I divide complex tasks into smaller steps to measure progress toward a goal.
I prioritize tasks and allocate resources.
I adjust plans as needed according to situational/strategic changes.

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

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

    
    
47. Strengths
    
    
    
48. Areas for Development
    
    
    
49. Please give any final comments or suggestions for [Participant Name Here]'s assessment.