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

Change Management	Needs Significant Improvement	Could benefit from Development	Capable and Effective	Role Model
I develop strategies for implementing changes.
You support the Company's efforts to implement changes.
I am able to get team members to change their attitudes.
You are effective in implementing new organizational vision and values.
I am able to get department employees to accept new changes.
Juggling Multiple Responsibilities	Needs Significant Improvement	Could benefit from Development	Capable and Effective	Role Model
You plan and organize continuously while performing all other responsibilities and activities.
You switch attention to more urgent tasks when necessary.
You ensure that assignments are prioritized according to the needs of the department/company.
You are aware of the deadlines for specific tasks/assignments.
You organize tasks for the most efficient order of completion.
Managing Risk	Needs Significant Improvement	Could benefit from Development	Capable and Effective	Role Model
I am responsible for regulatory, strategic, operational and project risk management.
You accurately perceive potential risks in the workplace and initiates preventative measures.
I accept risks as needed.
I determine the potential outcome of adverse risk events.
I promote risk management competence throughout the organization.
Safety	Needs Significant Improvement	Could benefit from Development	Capable and Effective	Role Model
You participate in safety training when offered.
You participate in safety training as applicable.
You participate in safety training when available.
You identify and addresses safety needs.
You are committed to safety in the workplace.
Interpersonal Skills	Needs Significant Improvement	Could benefit from Development	Capable and Effective	Role Model
You value the opinions of others.
You are a role model for others demonstrating the importance of interpersonal skills.
I take time to recognize the efforts of others.
I am willing to overlook personal differences and focus on completing the task at hand.
I work diligently to assist customers in finding the right products.
Integrity	Needs Significant Improvement	Could benefit from Development	Capable and Effective	Role Model
You foster an environment built upon trust.
You protect the integrity and confidentiality of information
You demonstrate sincerity in actions with others.
You develop trust and confidence from others.
You demonstrate honesty and truthfulness at all times.
Feedback	Needs Significant Improvement	Could benefit from Development	Capable and Effective	Role Model
You are visible and approachable.
You are easy to approach with ideas and opinions.
You look to others for input.
You share past experiences with others as learning opportunities.
You ask others for their ideas and opinions.
Client Focus	Needs Significant Improvement	Could benefit from Development	Capable and Effective	Role Model
I actively listen to concerns from clients.
I meet with clients on a regular basis.
I am available to respond to client needs.
You build trust with the client.
You obtain feedback to ensure client needs are being met.
Negotiation	Needs Significant Improvement	Could benefit from Development	Capable and Effective	Role Model
I control emotional responses to maintain a productive atmosphere.
You keep emotions in check to avoid negative outbursts.
I am an effective negotiator, fostering positive relationships and achieving good outcomes.
I understand the current situation of both parties.
You research the needs of the other party to identify strengths and weaknesses of positions.
Others	Needs Significant Improvement	Could benefit from Development	Capable and Effective	Role Model
You constructively receive criticism and suggestions from others.
You are able to see issues from others' perspectives.
You respect the opinions of other employees.
You form working relationships with employees from other departments.
You consistently demonstrate ability and willingness to trust others.
Company	Needs Significant Improvement	Could benefit from Development	Capable and Effective	Role Model
You understand the "basics" as to how [Company] functions/operates.
You impress upon others the important aspects of [Company].
You attend [Company] gatherings and social events.
You understand the use of [Company] products and services.
You follow existing procedures and processes.

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.