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
You adopt changes to set and example for others to follow.
You support the Company's efforts to implement changes.
You are effective in implementing new organizational vision and values.
You are effective in dealing with ambiguous and challenging situations.
You support new initiatives for organizational changes to improve effectiveness.
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 can multi-task while performing all of your other responsibilities and activities.
You observe, analyze, and respond to merchandise needs while serving customers and accomplishing operational tasks.
You plan and organize continuously while performing all other responsibilities and activities.
You maintain self-confidence and a positive mental attitude while facing challenging peaks and valleys of activities.
Managing Risk	Needs Significant Improvement	Could benefit from Development	Capable and Effective	Role Model
You avoid maintaining the status quo (or standard operating procedures) when addressing new and influential situations.
You know how to obtain desired results with minimal losses.
You are able to adapt quickly to changing situations.
You reward innovative experiments to try new ideas.
You maintain open communication with other departments.
Safety	Needs Significant Improvement	Could benefit from Development	Capable and Effective	Role Model
You identify and addresses safety needs.
You support our company's safety programs.
You create accurate and effective measures of safety.
You mitigate hazards and safety issues that arise.
You ensure compliance with safety regulations.
Interpersonal Skills	Needs Significant Improvement	Could benefit from Development	Capable and Effective	Role Model
You use knowledge and charisma rather than position, power, or coercion to influence others
You are a role model for others
You apply appropriate communication techniques to the situation.
You are open and approachable
You demonstrate willingness to work with others.
Integrity	Needs Significant Improvement	Could benefit from Development	Capable and Effective	Role Model
You develop trust and confidence from others.
You follow tasks to completion.
You maintain strong relationships with others.
You do what was promised.
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 actively seek feedback from others.
You share past experiences with others as learning opportunities.
You ask others for their ideas and opinions.
You are open to the suggestions of others.
Client Focus	Needs Significant Improvement	Could benefit from Development	Capable and Effective	Role Model
You form strong client relationships
You are pro-active in dealing with clients and addressing your needs.
You look for opportunities that have a positive impact on Clients.
You ensure client commitments and requirements are met or exceeded
You maintain strong relationships with clients.
Negotiation	Needs Significant Improvement	Could benefit from Development	Capable and Effective	Role Model
You establish clear communications to avoid misunderstandings.
You are able to decline bad ideas to avoid making poor decisions.
You understand the expectations of other parties in the negotiation.
You influence others through rational argument and persuasion.
You are able to adapt to changing situations.
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 work across boundaries within the organization.
You are able to see issues from others' perspectives.
You are able to see issues from others' perspectives.
You form working relationships with employees from other departments.
Company	Needs Significant Improvement	Could benefit from Development	Capable and Effective	Role Model
You understand the use of [Company] products and services.
You understand how decisions impact other business units beyond your immediate department of work group.
You attend [Company] gatherings and social events.
You express loyalty and dedication to [Company] in interactions with others.
You impress upon others the important aspects of [Company].

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.