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 work cooperatively with others to implement changes.
I inspire others to accept changes.
You are effective in dealing with ambiguous and challenging situations.
You adopt changes to set and example for others to follow.
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 spend the most time and effort on critical tasks first.
You assess current capabilities before committing to new requests from customers.
You avoid bottlenecks in progress by assigning multiple individuals to critical tasks.
You rank the importance of tasks to make sure critical tasks are completed first.
You integrate developing others with driving sales, serving customers, merchandising, performing operational procedures, and maintaining an appealing store environment.
Managing Risk	Needs Significant Improvement	Could benefit from Development	Capable and Effective	Role Model
You are aware of appropriate actions to minimize risks.
You determine the impact of specific risks on marketplace.
I determine a proportional response in relation to the level of risk.
You understand the possible financial risks of different events.
I establish good controls over the process to better manage risks.
Safety	Needs Significant Improvement	Could benefit from Development	Capable and Effective	Role Model
You seek to reduce the likelihood of accidents.
You develop a strong safety culture.
You work to implement corrective safety measures.
You develop a sustainable safety culture.
You identify predictable hazards in the workplace.
Interpersonal Skills	Needs Significant Improvement	Could benefit from Development	Capable and Effective	Role Model
I promote acceptance of diverse viewpoints from team members.
You demonstrate willingness to work with others.
You are a role model for others demonstrating the importance of interpersonal skills.
You a good listener who is attentive to others. I am a good listener who is attentive to others.
I am a highly respected individual in the company.
Integrity	Needs Significant Improvement	Could benefit from Development	Capable and Effective	Role Model
You foster an environment built upon trust.
You demonstrate sincerity in actions with others.
You do what was promised.
You demonstrate honesty and truthfulness at all times.
You maintain strong relationships with others.
Feedback	Needs Significant Improvement	Could benefit from Development	Capable and Effective	Role Model
You share past experiences with others as learning opportunities.
You seek feedback to enhance performance.
You are visible and approachable.
You look to others for input.
You actively seek feedback from others.
Client Focus	Needs Significant Improvement	Could benefit from Development	Capable and Effective	Role Model
You help clients feel they are receiving services tailored specifically to their needs.
I exhibit a positive attitude even when dealing with difficult clients.
I consistently meet client's needs.
I keep the client informed of all progress.
I identify opportunities that enhance the client's experience.
Negotiation	Needs Significant Improvement	Could benefit from Development	Capable and Effective	Role Model
You find shared interests and solutions that benefit all parties involved.
You adapt strategies to better meet the needs of the moment.
You are flexible in responses.
I understand the other person's needs, concerns, and motivations.
I can tailor my approache to more effectively address current demands.
Others	Needs Significant Improvement	Could benefit from Development	Capable and Effective	Role Model
You constructively receive criticism and suggestions from others.
You support the efforts of other employees in implementing solutions to problems.
You treat others with respect and dignity.
You consistently demonstrate ability and willingness to trust others.
You work effectively with people from other departments.
Company	Needs Significant Improvement	Could benefit from Development	Capable and Effective	Role Model
You understand the "basics" as to how [Company] functions/operates.
You understand the use of [Company] products and services.
You express loyalty and dedication to [Company] in interactions with others.
You attend [Company] gatherings and social events.
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.