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

• Conveys a sense of urgency about addressing problems and opportunities
• Completes a large volume of work.
• Completes work on time
• Seeks and utilizes opportunities for continuous learning and self-development.
• Encourages risk taking and experimentation to improve performance

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

Comments:

Cultural Awareness

• Shows respect in daily interactions
• Seeks knowledge and information about other cultures.
• Is aware of differences in how individuals from other cultures greet one another.
• Understands the impact that our culture may have on interactions between individuals.
• Understands what customs and etiquette are important for individuals from other cultures.

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

Comments:

Innovation

• Solves problems with insight and understanding.
• Analyzes current procedures and identifies opportunities for improvement.
• Takes risks to advance important ideas.
• Encourages open communication to ensure that all proposals are considered.
• Builds upon the ideas and solutions of others.

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

Comments:

Co-worker Development

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

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

Comments:

Planning

• Develops effective plans to deal with unforeseen circumstances.
• Sets up and monitors timeframes and plans
• Open to input from others into the plan for development of the strategic plan.
• Establishes and monitors timeframes and timelines.
• Accomplishes major tasks by breaking them into manageable pieces.

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.