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
You assist others in understanding changes to the organization.
I am able to get team members to change their attitudes.
You are effective in dealing with ambiguous and challenging situations.
You adopt changes to set and example for others to follow.
I am a leading force driving changes.
Juggling Multiple Responsibilities	Needs Significant Improvement	Could benefit from Development	Capable and Effective	Role Model
You complete multiple tasks simultaneously.
You integrate developing others with driving sales, serving customers, merchandising, performing operational procedures, and maintaining an appealing store environment.
You coordinate the work of a team by assigning tasks to other team members.
You recognize and respond to product placement and signing needs while staying alert to customers' needs, store activities and training associates.
You are aware of the deadlines for specific tasks/assignments.
Managing Risk	Needs Significant Improvement	Could benefit from Development	Capable and Effective	Role Model
You have the knowledge and skills to accurately identify risks in the workplace.
You are knowledgeable of standard risk management principles.
I decide what actions will be taken.
I identify the controls needed.
You perform regular risk analyses to minimize adverse outcomes.
Safety	Needs Significant Improvement	Could benefit from Development	Capable and Effective	Role Model
You perform work safely.
You participate in safety training when available.
You commit adequate resources toward safety measures.
You identify and addresses safety needs.
You ensure compliance with safety regulations.
Interpersonal Skills	Needs Significant Improvement	Could benefit from Development	Capable and Effective	Role Model
I keep commitments made with coworkers.
I am well respected in the department.
I recognize when others do a good job.
I promote acceptance of diverse viewpoints from team members.
You demonstrate good communication with colleagues and customers.
Integrity	Needs Significant Improvement	Could benefit from Development	Capable and Effective	Role Model
You establish relationships of trust, honesty, fairness, and integrity.
You do what was promised.
You develop trust and confidence from others.
You demonstrate honesty and truthfulness at all times.
You demonstrate sincerity in actions with others.
Feedback	Needs Significant Improvement	Could benefit from Development	Capable and Effective	Role Model
You seek feedback to enhance performance.
You are open to the suggestions of others.
You share past experiences with others as learning opportunities.
You are visible and approachable.
You ask others for their ideas and opinions.
Client Focus	Needs Significant Improvement	Could benefit from Development	Capable and Effective	Role Model
You make sure your interests are aligned with the client's interests.
I am available to respond to client needs.
You engage with clients on multiple levels.
I take the initiative in solving difficult client issues.
You help others in responding to client needs.
Negotiation	Needs Significant Improvement	Could benefit from Development	Capable and Effective	Role Model
You are able to express themselves in a clear, convincing, and logical manner.
You justify viewpoints using strong and credible data.
You ensure a thorough understanding of key issues and priorities.
I am aware of potential emotional triggers that could negatively impact the negotiations.
I engage in questioning to obtain necessary information and examine various alternatives.
Others	Needs Significant Improvement	Could benefit from Development	Capable and Effective	Role Model
You are able to see issues from others' perspectives.
You are able to see issues from others' perspectives.
You treat others with respect and dignity.
You form working relationships with employees from other departments.
You work effectively with people from other departments.
Company	Needs Significant Improvement	Could benefit from Development	Capable and Effective	Role Model
You attend [Company] gatherings and social events.
You impress upon others the important aspects of [Company].
You follow existing procedures and processes.
You understand the "basics" as to how [Company] functions/operates.
You understand the use of [Company] products and services.

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.