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
Communicates with clarity and efficiency.
Uses appropriate grammar and tense in communications.
Clarifies problems and their causes to help employees correct them.
Adjusts communication methods to the needs of the audience.
Administrative Skill	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Implements and uses performance measures.
Has strong technical/computer skills.
Takes responsibility for decisions.
Able to develop, justify and present a budget.
Time Management	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Ensures timely completion of critical assignments.
Manages work time and family life to bring both into balance.
Stays focused on the most important tasks that need completed.
Leaves time in the schedule for unplanned contingencies.
Results Oriented	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Flexible in adjusting priorities to meet the demands of changing situations.
Willing to adapt to new procedures to maintain production capacities.
Exceeds performance requirements.
Explains the "whys" behind organizational objectives
Technology Use/Management	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Proficient in the use of technical systems and processes.
Supports employee training and development initiatives regarding implementation of technology.
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
Keeps themselves and others focused on constant improvement.
Can be counted on to add value wherever they are involved.
Produces high quality work.
Demonstrates the analytical skills to do their job.
Safety	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Encourages others to attend safety training.
Keeps accurate safety records.
Performs work safely.
Committed to safety in the workplace.
Trustworthy	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Demonstrates congruence between statements and actions.
Takes care to maintain confidential information.
Delivers on promises made.
Demonstrates a sense of responsibility and commitment to public trust.
Responsible	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Completes assigned work tasks.
Sets a good example
Responsible for setting the vision of the department.
Sets a good example.
Developing Others	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Supports the successes of other employees.
Recognizes and celebrates accomplishments of others.
Sets performance objectives for subordinates that encourages development opportunities.
Encourages employees through recognition of positive changes in behavior.
Planning	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Determines the appropriate actions needed to achieve goals.
Notifies staff when the plan is not on schedule.
Ensures staff are held accountable for following the department plan.
Develops an effective plan to guide the 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.