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
Is clear about goals that need to be achieved.
Avoids creating ambiguity or mixed messages.
Maintains clarity in goals and objectives.
Adjusts communication methods to the needs of the audience.
Administrative Skill	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Takes responsibility for decisions.
Completes reports on-time.
Has strong technical/computer skills.
Accurately implements contract provisions.
Time Management	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Sets a good balance between work and family life.
Deals effectively with interruptions.
Uses agendas when chairing or facilitating meetings.
Sets clearly defined goals.
Results Oriented	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Directs team in prioritizing daily work activities
Inspires and motivates co-workers to be productive and energetic at work
Helps others when free-time is available.
Encourages a high-energy, fun work environment and coaches others on how to do the same
Technology Use/Management	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Supports technical training and development of employees.
Adopts the implementation of new technology into the workplace.
Uses technology in decision making and problem solving.
Applies complex rules and regulations to maintain optimal system performance.
Excellence	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Demonstrates the analytical skills to do their job.
Can be counted on to add value wherever they are involved.
Is planful and organized.
Produces high quality work.
Safety	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Develops a sustainable safety culture.
Develops a strong safety culture.
Mitigates hazards and safety issues that arise.
Is aware of OSHA safety guidelines.
Trustworthy	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Builds and maintains the trust of others.
Demonstrates congruence between statements and actions.
Communicates an understanding of the other person's interests, needs and concerns.
Demonstrates a sense of responsibility and commitment to public trust.
Responsible	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Sets a good example
Works in a way that makes others want to work with her/him.
Sets high personal standards of performance.
Sets a good example.
Developing Others	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Provides constructive feedback to others.
Creates opportunities for professional development.
Assigns tasks and responsibilities to develop skills of others.
Sets performance objectives for subordinates that encourages development opportunities.
Planning	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Establishes a course of action for self and others to accomplish specific goals.
Sets the appropriate sequence of tasks to ensure completion of the project.
Able to stay organized and focused using excellent planning skills.
Identifies resource requirements that may impact the development of the 5-year plan.

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.