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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Please ensure that your submission is made by .

Thank you for your participation in the survey.

Management Team

Clarity	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Provides a clear vision for the future.
Maintains clarity in goals and objectives.
Clearly explains responsibilities to individuals.
Communicates with clarity and efficiency.
Administrative Skill	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Completes reports on-time.
Able to develop, justify and present a budget.
Strong organizational skills to keep the workspace and department in order
Accurately implements contract provisions.
Time Management	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Makes time for developing plans and schedules.
Ensures timely completion of critical assignments.
Takes the initiative to tackle critical issues earlier rather than later.
Eliminates tasks that are unimportant for the job.
Results Oriented	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Keeps track of progress toward the results.
Directs team in prioritizing daily work activities
Achieves high levels of performance.
Inspires and motivates co-workers to be productive and energetic at work
Technology Use/Management	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Uses technology in decision making and problem solving.
Maximizes the use of new technology to deliver products and services.
Adopts the implementation of new technology into the workplace.
Applies complex rules and regulations to maintain optimal system performance.
Excellence	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Produces high quality work.
Is planful and organized.
Demonstrates the analytical skills to do their job.
Can be counted on to add value wherever they are involved.
Safety	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Mitigates hazards and safety issues that arise.
Develops safety guidelines for the department.
Participates in safety training as applicable.
Committed to safety in the workplace.
Trustworthy	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Seeks to mitigate grievances by clarifying intentions and finding suitable remedies.
Works in a way that makes others want to work with her/him.
Communicates an understanding of the other person's interests, needs and concerns.
Builds and maintains the trust of others.
Responsible	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Works in a way that makes others want to work with her/him.
Is a person you can trust.
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
Creates opportunities for professional development.
Recognizes and celebrates accomplishments of others.
Assesses employees' developmental needs.
Tries to ensure employees are ready to move to the next level.
Planning	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Develops effective plans to deal with unforeseen circumstances.
Reorders the schedule of events to maximize attendance/efficiency.
Ensures staff are held accountable for following the department plan.
Divides complex tasks into smaller steps to measure progress toward a goal.

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.