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 contribute to a positive and fun work environment.
You treat all people fairly and with respect.
You visibly support and encourages diversity in style and background.
You contribute to a positive work environment.
You are gracious and professional in your interactions with others.
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 work cooperatively with others to solve problems.
You are effective in solving problems.
You are able to balance the needs of different people in a solution to a problem.
You identify fresh approaches and shows a willingness to question traditional assumptions.
Technical	Role Model	Capable and Effective	Somewhat Effective	Needs Development
You keep current with technical advances within your professional discipline; embrace and apply new techniques and practices
You are naturally sought out by people outside your particular area for advice and opinion on a broad range of matters - not necessarily solely legal advice.
You demonstrate mastery of the technical competencies required in your work.
You know how to produce high quality products/work.
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 strong safety culture.
You are committed to safety in the workplace.
You participate in safety training when available.
You keep accurate safety records.
You develop a culture of safety.
Responsible	Role Model	Capable and Effective	Somewhat Effective	Needs Development
You complete assigned work tasks.
You are a person others can trust.
You take personal responsibility for results.
Your behavior is ethical and honest.
You act as a resource without removing individual responsibility.
Teamwork	Role Model	Capable and Effective	Somewhat Effective	Needs Development
You come across as a reliable, committed team member
You communicate a clear message that teamwork and collaboration are expected.
You encourage teamwork and collaboration.
You facilitate team discussions and problem-solving
You coach team members
Recognition	Role Model	Capable and Effective	Somewhat Effective	Needs Development
You recognize the abilities and skills of self and others
You let employees know when they have done well
You say "thank you" to show appreciation for work of others.
You offer recognition in a timely manner.
You make people around them feel appreciated and valued.
Fiscal Management	Role Model	Capable and Effective	Somewhat Effective	Needs Development
You monitor spending.
You provide budgeting and accounting support to the Company.
You develop of the department's annual budget.
You are effective in using company's resources.
You ensure others follow the correct rules and regulations on fiscal matters.
Planning	Role Model	Capable and Effective	Somewhat Effective	Needs Development
You anticipate obstacles and ways to overcome them.
You are able to identify the needs of the department before a major change.
You delegate role to team members to accomplish goals.
You anticipate potential challenges, develops plan to overcome them and then carries out the plan.
You make plans and follows through.

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.