Bias for Action - 360 Degree Feedback Survey Sample #12

360 Feedback Survey

Instructions

Thank you for providing feedback for the recipient above. As you respond, please draw on your first-hand experience with this individual in the past 12 months. Rate each item using the scale shown. If you don't feel you have enough first-hand information to rate a certain item, please choose the Not Applicable option. Comments can be very helpful; at a minimum where you give a particularly high or low rating, please share your reasons in the comment section for that competency. Your responses will be compiled with feedback from others and presented to the recipient to help guide their ongoing 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.

To what extent does [Participant Name] exhibit the following ...

SELECT the rating that best reflects the employee's performance in the areas listed.

Bias for Action

• Encourages risk taking and experimentation to improve performance
• Completes work on time
• Displays high energy and enthusiasm on consistent basis.
• Conveys a sense of urgency about addressing problems and opportunities
• Projects a "can-do" attitude when interfacing with peers, subordinates and customers(especially during difficult and challenging times).

Needs Improvement		Fully Proficient		Excels/ Role Model
Click this box to make your rating

Comments:

Cultural Awareness

• Shows respect in daily interactions
• Fosters a diverse workforce free from discrimination and harassment.
• Values the opinions of diverse groups and individual.
• Respects others regardless of age, race, gender, nationality, or disability.
• Recognizes and values individual and cultural differences.

Needs Improvement		Fully Proficient		Excels/ Role Model
Click this box to make your rating

Comments:

Innovation

• Builds upon the ideas and solutions of others.
• Suggests new ideas at meetings.
• Offers constructive improvements to existing systems.
• Challenges current procedures to develop other alternatives.
• Implements best practices within the department.

Needs Improvement		Fully Proficient		Excels/ Role Model
Click this box to make your rating

Comments:

Co-worker Development

• Gives others development opportunities through project assignments and increased job responsibilities
• Sets and clearly communicates expectations, performance goals, and measurements to others
• Works to identify root causes of performance problems
• Takes immediate action on poor performance
• Adapts coaching and mentoring approach to meet the style or needs of individuals

Needs Improvement		Fully Proficient		Excels/ Role Model
Click this box to make your rating

Comments:

Planning

• Delegates role to team members to accomplish goals.
• Makes plans and follows through.
• Anticipates obstacles and ways to overcome them.
• Able to look ahead (beyond the present) when addressing the work/needs of the department.
• Anticipates potential challenges, develops plan to overcome them and then carries out the plan.

Needs Improvement		Fully Proficient		Excels/ Role Model
Click this box to make your rating

Comments:

Strengths


Areas for Development


Please give any final comments or suggestions for [Participant Name Here]'s assessment.