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 show by your actions that you trust in the positive intentions of others.
You work to eliminate unnecessary work or barriers that get in others' way.
You visibly support and encourages diversity in style and background.
You are gracious and professional in your interactions with others.
You build open and trusting relationships.
Problem Solving	Role Model	Capable and Effective	Somewhat Effective	Needs Development
You are able to solve problems at root cause rather than at symptom level.
You understand the root causes of problems.
I am skilled at quickly diagnosing issues, identifying root causes, and developing and implementing effective solutions in the workplace.
You are able to balance the needs of different people in a solution to a problem.
You can develop innovative solutions to problems.
Technical	Role Model	Capable and Effective	Somewhat Effective	Needs Development
You know how to produce high quality products/work.
You willingly share information and expertise; sought out as resource by others
You are knowledgeable of procedures or systems necessary for the job.
You keep current with technical advances within your professional discipline; embrace and apply new techniques and practices
You use expertise to identify issues and think through creative solutions to get a problem solved or objective accomplished.
Safety	Role Model	Capable and Effective	Somewhat Effective	Needs Development
You develop a culture of safety.
You ensure compliance with safety regulations.
You perform work safely.
You support our company's safety programs.
You participate in safety training as applicable.
Responsible	Role Model	Capable and Effective	Somewhat Effective	Needs Development
You work in a way that makes others want to work with you.
You hold yourself accountable to goals / objectives
You set high personal standards of performance.
You act as a resource without removing individual responsibility.
Your behavior is ethical and honest.
Teamwork	Role Model	Capable and Effective	Somewhat Effective	Needs Development
I treat other team members with respect.
I am able to work closely other team members who are considered to be difficult to work with.
I facilitate effective teamwork during periods of change.
You demonstrate compassion and respect for others through actions; is concerned about their work and non-work issues
You facilitate team discussions and problem-solving
Recognition	Role Model	Capable and Effective	Somewhat Effective	Needs Development
You say "thank you" to show appreciation for work of others.
You recognize team members who offer a significant contribution to a project.
You find opportunities to recognize others.
You readily share credit and gives others opportunity for visibility.
You compliment other people when they do good work
Fiscal Management	Role Model	Capable and Effective	Somewhat Effective	Needs Development
You monitor spending.
You provide budgeting and accounting support to the Company.
You ensure others follow the correct rules and regulations on fiscal matters.
You develop of the department's annual budget.
You effectively manage appropriations, reporting, purchases, expenditures, payrolls, and staff.
Planning	Role Model	Capable and Effective	Somewhat Effective	Needs Development
I know how to create effective project plans.
I know how to create a timeline to specify when each phase of the project should be concluded.
You determine what supplies/equipment will be needed for the project.
I can create a timeline for events and monitors progress.
You set the appropriate sequence of tasks to efficiently achieve the goal.

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.