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 plans for following through on the changes.
I am able to get department employees to accept new changes.
You address organizational and departmental resistance to changes.
I inspire others to accept changes.
I inspire others to accept the recent changes.
Juggling Multiple Responsibilities	Needs Significant Improvement	Could benefit from Development	Capable and Effective	Role Model
You recognize and respond to product placement and signing needs while staying alert to customers' needs, store activities and training associates.
You manage impact of increased traffic flow and freight receipt by detailed planning of controllables and by anticipating and reacting positively to uncontrollables.
You rank the importance of tasks to make sure critical tasks are completed first.
You can multitask while performing all of your other responsibilities and activities.
You determine which tasks are critical and which tasks are optional.
Managing Risk	Needs Significant Improvement	Could benefit from Development	Capable and Effective	Role Model
You develop appropriate strategies to minimize risks.
You are committed to implementing rules and procedures to minimize risk.
You accurately perceive potential risks in the workplace.
You accurately determine appropriate risk levels (i.e., levels of acceptable risk).
You effectively respond to critical situations to reduce potential for losses.
Safety	Needs Significant Improvement	Could benefit from Development	Capable and Effective	Role Model
You develop a sustainable safety culture.
You create accurate and effective measures of safety.
You mitigate hazards and safety issues that arise.
You keep accurate safety records.
You identify predictable hazards in the workplace.
Interpersonal Skills	Needs Significant Improvement	Could benefit from Development	Capable and Effective	Role Model
You provide constructive feedback in a way that fosters acceptance and development.
You create an atmosphere that supports the open expression of ideas
You adapt management style to meet the needs of the individual or situation.
You anticipate the concerns of other employees.
You effectively manage conflicts by dealing with them directly and immediately
Integrity	Needs Significant Improvement	Could benefit from Development	Capable and Effective	Role Model
You do what was promised.
You establish relationships of trust, honesty, fairness, and integrity.
You foster a high standard of ethics and integrity.
You accept responsibility for mistakes.
You follow tasks to completion.
Feedback	Needs Significant Improvement	Could benefit from Development	Capable and Effective	Role Model
You look to others for input.
You are visible and approachable.
You consider other's opinion and suggestions.
You seek feedback to enhance performance.
You are easy to approach with ideas and opinions.
Client Focus	Needs Significant Improvement	Could benefit from Development	Capable and Effective	Role Model
I identify the core needs of the client.
You use client feedback to help improve products and services.
You understand the needs of the client.
You create innovative solutions for the clients.
You anticipate potential obstacles to meeting client needs.
Negotiation	Needs Significant Improvement	Could benefit from Development	Capable and Effective	Role Model
You stay calm and focus on the core issues to be discussed.
You are able to decline bad ideas to avoid making poor decisions.
You resolve difficult negotiations whether it is a contract, sub contract, legal or any other difficult negotiation fairly and reasonably.
You research the needs of the other party to identify strengths and weaknesses of positions.
You understand the expectations of other parties in the negotiation.
Others	Needs Significant Improvement	Could benefit from Development	Capable and Effective	Role Model
You constructively receive criticism and suggestions from others.
You consistently demonstrate ability and willingness to trust others.
You treat others with respect and dignity.
You work effectively with people from other departments.
You work across boundaries within the organization.
Company	Needs Significant Improvement	Could benefit from Development	Capable and Effective	Role Model
You understand the "basics" as to how [Company] functions/operates.
You attend [Company] gatherings and social events.
You understand how decisions impact other business units beyond your immediate department of work group.
You impress upon others the important aspects of [Company].
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.