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

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Attitude	Needs Significant Improvement	Could benefit from Development	Capable and Effective	Role Model
Is gracious and professional in their interactions with others.
Works to eliminate unnecessary work or barriers that get in others' way.
Shows by their actions that they trust in the positive intentions of others.
Contributes to a positive and fun work environment.
Visibly supports and encourages diversity in style and background.
Accountability	Needs Significant Improvement	Could benefit from Development	Capable and Effective	Role Model
Aware of the consequences for failure to complete the project.
Maintains honesty and transparency in all communications.
Exhibits good governance in their role as an executive.
Consistently exhibits professionalism in interactions with employees.
Reviews performance to determine areas for improvement.
Integrity	Needs Significant Improvement	Could benefit from Development	Capable and Effective	Role Model
Protects the integrity and confidentiality of information
Accepts responsibility for mistakes.
Demonstrates sincerity in actions with others.
Fosters an environment built upon trust.
Fosters a high standard of ethics and integrity.
Punctuality	Needs Significant Improvement	Could benefit from Development	Capable and Effective	Role Model
Starts meetings on time.
Responds to requests for information in a timely manner.
Arrives to meetings on time.
Avoids making personal phone calls during working hours.
Starts the workday when scheduled.
Change Management	Needs Significant Improvement	Could benefit from Development	Capable and Effective	Role Model
Effective in implementing new organizational vision and values.
Adopts changes to set and example for others to follow.
Supports the Company's efforts to implement changes.
Supports new initiatives for organizational changes to improve effectiveness.
Effective in dealing with ambiguous and challenging situations.
Safety	Needs Significant Improvement	Could benefit from Development	Capable and Effective	Role Model
Points out behaviors in others that may be unsafe.
Performs work safely.
Supports our company's safety programs.
Is aware of OSHA safety guidelines.
Seeks to reduce the likelihood of accidents.
Responsible	Needs Significant Improvement	Could benefit from Development	Capable and Effective	Role Model
Works in a way that makes others want to work with her/him.
Holds herself / himself accountable to goals / objectives
Completes assigned work tasks.
Responsible for setting the vision of the department.
Sets a good example.
Conflict Management	Needs Significant Improvement	Could benefit from Development	Capable and Effective	Role Model
Uses structured frameworks for resolving conflicts, such as mediation or facilitated discussions.
Promotes a culture that values diverse perspectives.
Determines who has the autonomy (authority) to make the decisions necessary to end the conflict.
Helps employees to think through alternative ways to resolve conflict situations.
Combines different ideas and viewpoints.

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.