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 address organizational and departmental resistance to changes.
You support the Company's efforts to implement changes.
You adopt changes to set and example for others to follow.
I am able to get team members to change their attitudes.
Juggling Multiple Responsibilities	Needs Significant Improvement	Could benefit from Development	Capable and Effective	Role Model
You assign tasks based on skills of team members.
You rank the importance of tasks to make sure critical tasks are completed first.
You are aware of the deadlines for specific tasks/assignments.
You recognize and respond to product placement and signing needs while staying alert to customers' needs, store activities and training associates.
You begin tasks as soon as possible.
Managing Risk	Needs Significant Improvement	Could benefit from Development	Capable and Effective	Role Model
You effectively respond to critical situations to reduce potential for losses.
You base decisions on patterns found in fluid/changing information.
You are committed to implementing rules and procedures to minimize risk.
You are able to perceive the risks of different work tasks and activities.
You reward innovative experiments to try new ideas.
Safety	Needs Significant Improvement	Could benefit from Development	Capable and Effective	Role Model
You identify predictable hazards in the workplace.
You ensure that all supervisors are aware of regulatory and compliance measures.
You ensure compliance with safety regulations.
You are aware of osha safety guidelines.
You work to implement corrective safety measures.
Interpersonal Skills	Needs Significant Improvement	Could benefit from Development	Capable and Effective	Role Model
I offer praise to colleagues who have successfully completed major projects.
You are open and approachable
I am thoughtful and honest about the feedback I give others.
I am willing to overlook personal differences and focus on completing the task at hand.
I am well respected in the department.
Integrity	Needs Significant Improvement	Could benefit from Development	Capable and Effective	Role Model
You demonstrate honesty and truthfulness at all times.
You develop trust and confidence from others.
You demonstrate sincerity in actions with others.
You foster a high standard of ethics and integrity.
You protect the integrity and confidentiality of information
Feedback	Needs Significant Improvement	Could benefit from Development	Capable and Effective	Role Model
You ask others for their ideas and opinions.
You consider other's opinion and suggestions.
You accept the views of others.
You are open to the suggestions of others.
You share past experiences with others as learning opportunities.
Client Focus	Needs Significant Improvement	Could benefit from Development	Capable and Effective	Role Model
You make client's needs a top priority.
I meet with clients on a regular basis.
I ensure that commitments made to clients are completed to the client's satisfaction.
You deliver on commitments made to clients.
I tailor innovative products for each client.
Negotiation	Needs Significant Improvement	Could benefit from Development	Capable and Effective	Role Model
You understand the expectations of other parties in the negotiation.
You research the needs of the other party to identify strengths and weaknesses of positions.
You are able to control your emotional responses and correctly gauge the emotions of others.
You maintain communication channels between parties in the negotiation.
You leverage relationships with others to achieve goals.
Others	Needs Significant Improvement	Could benefit from Development	Capable and Effective	Role Model
You support the efforts of other employees in implementing solutions to problems.
You are able to see issues from others' perspectives.
You are able to see issues from others' perspectives.
You include others in the decision making processes.
You treat others with respect and dignity.
Company	Needs Significant Improvement	Could benefit from Development	Capable and Effective	Role Model
You attend [Company] gatherings and social events.
You follow existing procedures and processes.
You impress upon others the important aspects of [Company].
You express loyalty and dedication to [Company] in interactions with others.
You understand how decisions impact other business units beyond your immediate department of work group.

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.