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.

Partially completed forms can be saved by using the Save/Still Working button at the bottom of the page. You may return at a later time to complete/edit the form. Your saved responses will be shown each time you re-visit the feedback form. When you are certain that you have completed your responses and will be not making any changes, click the Complete button.

Please ensure that your submission is made by .

Thank you for your participation in the survey.

Management Team

Edit this Survey

Would you like to edit this survey? Click here to begin.

Clarity	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Adjusts communication methods to the needs of the audience.
Makes sure employees understand why they were given certain assignments.
Provides a clear vision for the future.
Maintains clarity in goals and objectives.
Administrative Skill	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Implements and uses performance measures.
Enthusiastic about taking on challenging projects.
Able to develop, justify and present a budget.
Completes reports on-time.
Time Management	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Sets time limits on how much time is spent on particular tasks so that one task does not dominate the schedule.
Utilizes batch workflows to reduce time spent on certain tasks.
Uses automation when possible to save time.
Makes the most of limited time available.
Results Oriented	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Helps the team maintain focus on the goals.
Determined to complete tasks regardless of obstacles that may occur.
Makes sure employees have the resources they need to achieve their results.
Is considered a high achiever.
Technology Use/Management	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Supports employee training and development initiatives regarding implementation of technology.
Supports technical training and development of employees.
Applies complex rules and regulations to maintain optimal system performance.
Maximizes the use of new technology to deliver products and services.
Excellence	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Takes a lot of pride in their work.
Can be counted on to add value wherever they are involved.
Is planful and organized.
Keeps themselves and others focused on constant improvement.
Safety	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Supports safety programs and procedures.
Participates in safety training when offered.
Develops a culture of safety.
Keeps accurate safety records.
Trustworthy	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Seeks to mitigate grievances by clarifying intentions and finding suitable remedies.
Is trustworthy; is someone I can trust.
Works in a way that makes others want to work with her/him.
Takes ownership, delivers on commitments
Responsible	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Responsible for setting the vision of the department.
Acts as a resource without removing individual responsibility.
...takes personal responsibility for results.
Completes assigned work tasks.
Developing Others	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Creates opportunities for professional development.
Provides constructive feedback to others.
Supports the successes of other employees.
Creates a work environment that fosters positive feedback to employees.
Planning	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Determines the amount of materials/supplies needed for the project.
Able to balance the needs of multiple stakeholders in developing the plan for the division.
Notifies staff when the plan is not on schedule.
Anticipates resources needed to successfully implement a plan or project.

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.