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
Uses appropriate grammar and tense in communications.
Communicates ideas and facts clearly and effectively in writing.
Maintains clarity in goals and objectives.
Attends to the important details of a job or task.
Administrative Skill	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Able to develop, justify and present a budget plan.
Selects and uses training/instructional methods and procedures appropriate for the situation when learning or teaching new things.
Follows company guidelines, policies, regulations, procedures, and work ethics.
Prepares and reviews operational reports and schedules to ensure accuracy and efficiency.
Time Management	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Often works through lunches instead of going out for lunches.
Manages the workload effectively in order to stay on schedule.
Rarely misses deadlines; often producing results before expected.
Leaves time in the schedule for unplanned contingencies.
Results Oriented	Role Model	Capable and Effective	Somewhat Effective	Needs Development
clearly defines roles and expectations.
Anticipates potential obstacles and builds contingency plans to maintain momentum.
Reviews historical performance data to inform future planning decisions.
Prioritizes goals to complete those in urgent need first.
Technology Use/Management	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Uses technology in decision making and problem solving.
Supports technical training and development of employees.
Identifies gaps between actual and needed technical competencies and provides recommendations for required training.
Adopts the implementation of new technology into the workplace.
Excellence	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Keeps themselves and others focused on constant improvement.
Can be counted on to add value wherever they are involved.
Demonstrates the analytical skills to do their job.
Is planful and organized.
Safety	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Is aware of OSHA safety guidelines.
Develops a culture of safety.
Identifies predictable hazards in the workplace.
Encourages others to attend safety training.
Trustworthy	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Builds and maintains the trust of others.
Takes care to maintain confidential information.
Demonstrates congruence between statements and actions.
Is a person you can trust.
Responsible	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Completes assigned work tasks.
Sets a good example.
Sets high personal standards of performance.
Responsible for setting the vision of the department.
Developing Others	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Tries to ensure employees are ready to move to the next level.
Assigns tasks and responsibilities to develop skills of others.
Creates a work environment that fosters positive feedback to employees.
Provides constructive feedback to others.
Planning	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Is able to follow the plan set in place.
Determines the allocation of funds based on plans for future development.
Creates plans to handle complex, multi-faceted projects.
Ensures everyone in the department is onboard with the current 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.