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

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Attitude	Role Model	Capable and Effective	Somewhat Effective	Needs Development
You offer constructive criticism.
I support alternative approaches and encourage creative problem-solving when roadblocks arise.
You volunteer for tasks or initiatives that stretch your skills, showing eagerness to contribute and grow.
I encourage openness and constructive dialogue around the changes.
You stand by decisions when appropriate, demonstrating thoughtful risk-taking and ownership.
Problem Solving	Role Model	Capable and Effective	Somewhat Effective	Needs Development
You determine the order in which the action steps need to be completed including steps that may be dependent on others.
I ensure that critical aspects of the solution to the problem are well-supported and less likely to encounter issues.
You can develop innovative solutions to problems.
I establish the sequence of tasks, taking into account dependencies.
I compare the proposed solutions against each other and against any existing solutions to determine which one is likely to yield the best results.
Technical	Role Model	Capable and Effective	Somewhat Effective	Needs Development
You use expertise to identify issues and think through creative solutions to get a problem solved or objective accomplished.
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 willingly share information and expertise; sought out as resource by others
You seek information from others as needed.
Safety	Role Model	Capable and Effective	Somewhat Effective	Needs Development
You support safety programs and procedures.
You participate in safety training as applicable.
You commit adequate resources toward safety measures.
You are aware of osha safety guidelines.
You seek to reduce the likelihood of accidents.
Responsible	Role Model	Capable and Effective	Somewhat Effective	Needs Development
You are a person others can trust.
You act as a resource without removing individual responsibility.
You are responsible for setting the vision of the department.
You work in a way that makes others want to work with you.
Your behavior is ethical and honest.
Teamwork	Role Model	Capable and Effective	Somewhat Effective	Needs Development
I am able to work closely other team members who are considered to be difficult to work with.
I work well with other team members.
You share resources and information with the team.
You relate to all kinds of people tactfully
You foster teamwork rather than individual competition
Recognition	Role Model	Capable and Effective	Somewhat Effective	Needs Development
You link recognition to the employee's professional development and growth.
You recognize team members who offer a significant contribution to a project.
I highlight specific contributions, demonstrating to employees how their efforts support department goals and drive success.
You measure the quality of recognition that team leaders give their team members.
You use a systematic approach to implementing recognition programs.
Fiscal Management	Role Model	Capable and Effective	Somewhat Effective	Needs Development
You monitor expenses and verify the need for items purchased.
You keep excellent records for financial transparency.
You ensure others follow the correct rules and regulations on fiscal matters.
You develop of the department's annual budget.
You monitor spending.
Planning	Role Model	Capable and Effective	Somewhat Effective	Needs Development
You understand what materials will be required to successfully implement the plan.
I am able to efficiently manage deadlines.
I can determine the amount of materials/supplies needed for the project.
I prioritize tasks based on urgency/need.
I understand what equipment will be needed for the project.

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.