Attitude - 360 Degree Feedback Survey Sample #5

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

Attitude	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Contributes to a positive and fun work environment.
Shows by their actions that they trust in the positive intentions of others.
Treats all people fairly and with respect.
Visibly supports and encourages diversity in style and background.
Works to eliminate unnecessary work or barriers that get in others' way.
Problem Solving	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Effective in solving problems.
Is a good problem solver and decision maker
Solves problems using logic and insight.
Ability to develop innovative solutions to problems.
Works cooperatively with others to solve problems.
Technical	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Demonstrates mastery of the technical competencies required in his/her work.
Is naturally sought out by people outside his/her particular area for advice and opinion on a broad range of matters - not necessarily solely legal advice.
Uses expertise to identify issues and think through creative solutions to get a problem solved or objective accomplished.
Keeps current with technical advances within his/her professional discipline; embraces and applies new techniques and practices
Willingly shares information and expertise; sought out as resource by others
Safety	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Works to implement corrective safety measures.
Participates in safety training when offered.
Develops safety guidelines for the department.
Mitigates hazards and safety issues that arise.
Identifies predictable hazards in the workplace.
Responsible	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Sets a good example
Sets high personal standards of performance.
Completes assigned work tasks.
...takes personal responsibility for results.
Is a person you can trust.
Teamwork	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Fosters teamwork rather than individual competition
Encourages teamwork and collaboration.
Demonstrates compassion and respect for others through actions; is concerned about their work and non-work issues
Recognizes and respects the contributions and needs of each individual.
Provides assistance and support to other team members when needed
Recognition	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Readily shares credit and gives others opportunity for visibility.
Lets employees know when they have done well
Recognizes individuals for a specific outstanding achievement.
Says "thank you" to show appreciation for work of others.
Recognizes the abilities and skills of self and others
Fiscal Management	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Keeps excellent records for financial transparency.
Effective in using Company's resources.
Effectively manages appropriations, reporting, purchases, expenditures, payrolls, and staff.
Monitors expenses and verifies the need for items purchased.
Monitors spending.
Planning	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Anticipates potential challenges, develops plan to overcome them and then carries out the plan.
Delegates role to team members to accomplish goals.
Makes plans and follows through.
Anticipates obstacles and ways to overcome them.
Works in an organized manner

46. Overall, please rate the effectiveness of .
    

    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 's assessment.