Attitude - 360 Degree Feedback Survey Sample #6

360-Degree Assessment Survey

Dear Employee:

You have been selected to provide feedback on the employee listed above. Your feedback is an important part of our company's leadership development process and this survey is intended to gather broad feedback in the core competencies and role responsibilities that are important for the on-going success of our organization.

In responding to the questions below, think about your experiences working with this employee over the last twelve months. The effectiveness of this development tool is dependent on your honest, forthright and constructive responses so please bear this in mind as you answer each question. Your responses will be aggregated with the responses received from others and discussed with the employee to foster growth and on-going development.

We encourage everyone to complete the survey. Please be honest, constructive and thoughtful in your input. The survey is designed to help us understand more about your thoughts and needs to make this a great company.

The results of this survey will be used to help drive our future success. We will report back to you about what you have said and what we plan to do about it. If you have any questions about the process please contact [Contact Person].

Please ensure that your submission is made between . The survey will only be available during these dates.

Thank you for your participation in the survey. We look forward to seeing the analysis of your responses and we are hoping for 100% participation.

Management Team

Attitude	Needs Significant Improvement	Could benefit from Development	Capable and Effective	Role Model
Contributes to a positive and fun work environment.
Treats all people fairly and with respect.
Contributes to a positive work environment.
Builds open and trusting relationships.
Visibly supports and encourages diversity in style and background.
Accountability	Needs Significant Improvement	Could benefit from Development	Capable and Effective	Role Model
Always keeps the supervisor informed of relevant information.
Exhibits good governance in their role as an executive.
Holds employees responsible if expectations are not met.
Encourages employees to take on greater responsibilities.
Takes responsibility for the team's actions and results.
Integrity	Needs Significant Improvement	Could benefit from Development	Capable and Effective	Role Model
Demonstrates honesty and truthfulness at all times.
Accepts responsibility for mistakes.
Demonstrates sincerity in actions with others.
Establishes relationships of trust, honesty, fairness, and integrity.
Does what was promised.
Punctuality	Needs Significant Improvement	Could benefit from Development	Capable and Effective	Role Model
Conducts appointments at scheduled start time.
Responds to requests for information in a timely manner.
Invoices clients on a timely basis.
Maintains an efficient schedule of activities.
Avoids making personal phone calls during working hours.
Change Management	Needs Significant Improvement	Could benefit from Development	Capable and Effective	Role Model
Inspires others to accept changes.
Supports the Company's efforts to implement changes.
Able to get team members to change their attitudes.
Assists others in understanding changes to the organization.
Effective in dealing with ambiguous and challenging situations.
Safety	Needs Significant Improvement	Could benefit from Development	Capable and Effective	Role Model
Is aware of OSHA safety guidelines.
Creates accurate and effective measures of safety.
Performs work safely.
Supports our company's safety programs.
Ensures that all supervisors are aware of regulatory and compliance measures.
Responsible	Needs Significant Improvement	Could benefit from Development	Capable and Effective	Role Model
Sets a good example
Responsible for setting the vision of the department.
Sets a good example.
Is a person you can trust.
Holds herself / himself accountable to goals / objectives
Conflict Management	Needs Significant Improvement	Could benefit from Development	Capable and Effective	Role Model
Identifies and takes steps to prevent potential confrontations.
Clearly expresses expectations to others.
Helps employees to think through alternative ways to resolve conflict situations.
Assists team members by helping them see the other point of view.
Deals effectively with employee grievances.

41. Overall, please rate the effectiveness of [Participant Name Here].
    

    5- Very Effective 4- Effective 3- Neither 2- Ineffective 1- Very Ineffective

    
    
42. Describe the greatest strengths of this person with regard to his/her overall effectiveness in performing his/her current responsibilities.
    
    
    
43. Describe the most important things this person could improve upon in order to increase his/her overall effectiveness in performing his/her current responsibilities.
    
    
    
44. Additional comments, if any for [Participant Name Here]'s assessment.