Change Management - 360 Degree Feedback Survey Sample #6

360-Degree Assessment Survey

Dear Employee:

You have been selected to participate in a 360-assessment. As part of this process you will need to complete the self-assessment questionnaire below.

In responding to the questions below, think about your experiences over the last 12 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. A report will be shared with you at the conclusion of this project.

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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Change Management	Needs Significant Improvement	Could benefit from Development	Capable and Effective	Role Model
I am able to get department employees to accept new changes.
You collaborate with peers and subject matter experts to prepare for changes.
You clearly explain what change are needed.
I encourage employee involvement in decisions regard the change and in implementation of solutions.
You remain calm in situations that may involve significant changes.
Juggling Multiple Responsibilities	Needs Significant Improvement	Could benefit from Development	Capable and Effective	Role Model
You integrate developing others with driving sales, serving customers, merchandising, performing operational procedures, and maintaining an appealing store environment.
You plan and organize continuously while performing all other responsibilities and activities.
You determine which tasks are critical and which tasks are optional.
You rank the importance of tasks to make sure critical tasks are completed first.
You keep track of multiple assignments and deadlines.
Managing Risk	Needs Significant Improvement	Could benefit from Development	Capable and Effective	Role Model
I determine which are the serious threats.
You develop appropriate strategies to minimize risks.
You accurately perceive potential risks in the workplace.
I understand how to meet regulatory compliance.
You create informative guides regarding potential risks and risky behaviors.
Safety	Needs Significant Improvement	Could benefit from Development	Capable and Effective	Role Model
You support our company's safety programs.
You encourage others to work safely.
You are aware of osha safety guidelines.
You are committed to safety in the workplace.
You encourage others to attend safety training.
Interpersonal Skills	Needs Significant Improvement	Could benefit from Development	Capable and Effective	Role Model
I demonstrate a high degree of ethics and integrity in the workplace.
I am well respected in the department.
I am willing to overlook personal differences and focus on completing the task at hand.
You use tact, compassion, and sensitivity in interactions with others.
You address critical customer issues in a timely manner.
Integrity	Needs Significant Improvement	Could benefit from Development	Capable and Effective	Role Model
You show steadfast integrity, dedication, and excellence, persistently seeking to make a meaningful impact and bolster the company's success.
I ensure employee compensation is administer fairly based on pre-established rules and regulations.
You demonstrate honesty and truthfulness at all times.
I distribute the workload evenly among all team members.
I maintain strong trust-based relationships by being open, honest and transparent.
Feedback	Needs Significant Improvement	Could benefit from Development	Capable and Effective	Role Model
You seek out different perspectives on important issues.
You maintain the integrity and confidentiality of feedback givers.
You use feedback as a catalyst for self-reflection and development.
You implement actionable strategies to address any issues identify through feedback.
You embrace feedback to help to build self-awareness.
Client Focus	Needs Significant Improvement	Could benefit from Development	Capable and Effective	Role Model
You document client interactions.
I take the initiative in solving difficult client issues.
I create an environment that enables clients to receive excellent service.
I provide training to others on how to improve client service.
I foster an environment that supports strong client focus.
Negotiation	Needs Significant Improvement	Could benefit from Development	Capable and Effective	Role Model
You ensure a thorough understanding of key issues and priorities.
You keep emotions in check to avoid negative outbursts.
You justify viewpoints using strong and credible data.
I always have a "game plan" prior to entering into negotiations.
I use the motivations of each party to identify mutually advantageous solutions.
Others	Needs Significant Improvement	Could benefit from Development	Capable and Effective	Role Model
You respect the opinions of other employees.
You treat others with respect and dignity.
You work across boundaries within the organization.
You support the efforts of other employees in implementing solutions to problems.
You include others in the decision making processes.
Company	Needs Significant Improvement	Could benefit from Development	Capable and Effective	Role Model
I translate company-wide initiatives into actionable goals for the team.
I make sure employees are aware of the company's financial situation.
I am proud of the work done by employees in the department.
You ensure employees have all the tools and equipment need to maintain production schedules.
You support [Company]'s marketing efforts.

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

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

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