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 work to eliminate unnecessary work or barriers that get in others' way.
You are gracious and professional in your interactions with others.
You build open and trusting relationships.
You contribute to a positive and fun work environment.
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 a good problem solver and decision maker
You identify fresh approaches and shows a willingness to question traditional assumptions.
You find creative ways to get things done with limited resources.
You identify and assess all potential responses to a problem.
You understand the root causes of problems.
Technical	Role Model	Capable and Effective	Somewhat Effective	Needs Development
You are knowledgeable of procedures or systems necessary for the job.
You seek information from others as needed.
You use expertise to identify issues and think through creative solutions to get a problem solved or objective accomplished.
You willingly share information and expertise; sought out as resource by others
You willingly share your technical expertise; sought out as resource by others
Safety	Role Model	Capable and Effective	Somewhat Effective	Needs Development
You participate in safety training when available.
You keep accurate safety records.
You identify predictable hazards in the workplace.
You develop safety guidelines for the department.
You seek to reduce the likelihood of accidents.
Responsible	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Your behavior is ethical and honest.
You set a good example
You complete assigned work tasks.
You work in a way that makes others want to work with you.
You act as a resource without removing individual responsibility.
Teamwork	Role Model	Capable and Effective	Somewhat Effective	Needs Development
You encourage open communication
You actively participates in the work of teams; seek and listen to others' contributions
You encourage teamwork and collaboration.
You share credit for accomplishments with team members
You build consensus and share relevant information.
Recognition	Role Model	Capable and Effective	Somewhat Effective	Needs Development
You recognize the abilities and skills of self and others
You reinforce and reward employees for accomplishing necessary goals.
You offer recognition in a timely manner.
You are sincerely interested in the suggestions of co-workers
You say "thank you" to show appreciation for work of others.
Fiscal Management	Role Model	Capable and Effective	Somewhat Effective	Needs Development
You ensure others follow the correct rules and regulations on fiscal matters.
You develop budgets and plans for various programs and initiatives.
You monitor expenses and verify the need for items purchased.
You monitor spending.
You are effective in using company's resources.
Planning	Role Model	Capable and Effective	Somewhat Effective	Needs Development
I determine the appropriate actions needed to achieve goals.
I conduct regular assessments of the project status to ensure adherence to the set schedule.
I am open to input from others into the plan for development of the strategic plan.
You establish and monitor timeframes and timelines.
I can develop good plans used for logistics.

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.