Clarity - 360 Degree Feedback Survey Sample #5

360-Degree Assessment Survey

Dear Employee:

Thank you for providing feedback for the recipient above. As you respond, please draw on your first-hand experience with this individual in the past 12 months. Rate each item using the scale shown. If you don't feel you have enough first-hand information to rate a certain item, please choose the Not Applicable option. Comments can be very helpful; at a minimum where you give a particularly high or low rating, please share your reasons in the Closing Comments section. Your responses will be compiled with feedback from others and presented to the recipient to help guide their ongoing development.

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Thank you for your participation in the survey.

Management Team

Clarity	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Attends to the important details of a job or task.
Writes clear job descriptions for positions in the organization.
Is clear about goals that need to be achieved.
Avoids creating ambiguity or mixed messages.
Administrative Skill	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Accurately implements contract provisions.
Enthusiastic about taking on challenging projects.
Implements and uses performance measures.
Completes reports on-time.
Time Management	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Focuses on tasks that have high priority.
Keeps and maintains a To-Do list.
Prioritizes new tasks according to their relative importance.
Avoids distractions in the workplace.
Results Oriented	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Works toward achievement of goals even when confronted with obstacles.
Does not become distracted by non-issues or interruptions.
Helps others when free-time is available.
Inspires and motivates co-workers to be productive and energetic at work
Technology Use/Management	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Supports employee training and development initiatives regarding implementation of technology.
Uses technology in decision making and problem solving.
Supports technical training and development of employees.
Applies complex rules and regulations to maintain optimal system performance.
Excellence	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Is planful and organized.
Demonstrates the analytical skills to do their job.
Keeps themselves and others focused on constant improvement.
Can be counted on to add value wherever they are involved.
Safety	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Develops safety guidelines for the department.
Participates in safety training when available.
Creates accurate and effective measures of safety.
Supports our company's safety programs.
Trustworthy	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Builds and maintains the trust of others.
Takes ownership, delivers on commitments
Works in a way that makes others want to work with her/him.
Is a person you can trust.
Responsible	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Is a person you can trust.
Responsible for setting the vision of the department.
Holds herself / himself accountable to goals / objectives
Behavior is ethical and honest.
Developing Others	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Provides constructive feedback to others.
Assesses employees' developmental needs.
Creates a work environment that fosters positive feedback to employees.
Tries to ensure employees are ready to move to the next level.
Planning	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Delegates role to team members to accomplish goals.
Able to look ahead (beyond the present) when addressing the work/needs of the department.
Makes plans and follows through.
Anticipates obstacles and ways to overcome them.

45. Overall, please rate the effectiveness of [Participant Name Here].
    

    5- Very Effective 4- Effective 3- Neither 2- Ineffective 1- Very Ineffective

    
    
46. Strengths
    
    
    
47. Areas for Development
    
    
    
48. Please give any final comments or suggestions for [Participant Name Here]'s assessment.