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 visibly support and encourages diversity in style and background.
You show by your actions that you trust in the positive intentions of others.
You are gracious and professional in your interactions with others.
You build open and trusting relationships.
You contribute to a positive work environment.
Problem Solving	Role Model	Capable and Effective	Somewhat Effective	Needs Development
You are effective in solving problems.
You work cooperatively with others to solve problems.
You make judgments based upon relevant information.
You are able to solve problems at root cause rather than at symptom level.
I am skilled at quickly diagnosing issues, identifying root causes, and developing and implementing effective solutions in the workplace.
Technical	Role Model	Capable and Effective	Somewhat Effective	Needs Development
You willingly share your technical expertise; sought out as resource by others
You use expertise to identify issues and think through creative solutions to get a problem solved or objective accomplished.
You seek information from others as needed.
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.
Safety	Role Model	Capable and Effective	Somewhat Effective	Needs Development
You are not afraid to question a potential safety issue observed in the workplace.
You point out behaviors in others that may be unsafe.
You support our company's safety programs.
You support safety programs and procedures.
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 are a person others can trust.
Your behavior is ethical and honest.
You take personal responsibility for results.
You set a good example.
Teamwork	Role Model	Capable and Effective	Somewhat Effective	Needs Development
I consider the impact and implications of decisions on the team.
You are open to new ideas that may change own goals for benefit of the team
I encourage other team members to adopt new procedures.
You actively participates in the work of teams; seek and listen to others' contributions
You share resources and information with the team.
Recognition	Role Model	Capable and Effective	Somewhat Effective	Needs Development
You offer recognition in a timely manner.
You compliment other people when they do good work
You readily share credit and gives others opportunity for visibility.
You let employees know when they have done well
You are sincerely interested in the suggestions of co-workers
Fiscal Management	Role Model	Capable and Effective	Somewhat Effective	Needs Development
You develop budgets and plans for various programs and initiatives.
You effectively manage appropriations, reporting, purchases, expenditures, payrolls, and staff.
You are effective in using company's resources.
You keep excellent records for financial transparency.
You provide budgeting and accounting support to the Company.
Planning	Role Model	Capable and Effective	Somewhat Effective	Needs Development
I analyze market trends to plan the best course of action.
I develop plans used to accomplish urgent or critical tasks.
I plan for how to allocate time to specific activities.
I can determine the amount of materials/supplies needed for the project.
I am able to efficiently manage deadlines.

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.