Clarity - 360 Degree Feedback Survey Sample #5

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
Checks details thoroughly.
Avoids creating ambiguity or mixed messages.
Maintains clarity in goals and objectives.
Communicates ideas and facts clearly and effectively in writing.
Avoids stating unclear or conflicting goals.
Administrative Skill	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Completes reports on-time.
Implements and uses performance measures.
High attention to detail.
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
Deals effectively with interruptions.
Leaves time in the schedule for unplanned contingencies.
Prioritizes tasks to identify immediate and long-term objectives.
Uses agendas when chairing or facilitating meetings.
Avoids distractions in the workplace.
Results Oriented	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Encourages a high-energy, fun work environment and coaches others on how to do the same
Explains the "whys" behind organizational objectives
Does not become distracted by non-issues or interruptions.
Demonstrates the personal confidence to "stay the course," even when faced with difficulty
Provides clear expectations for employees.
Technology Use/Management	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Applies complex rules and regulations to maintain optimal system performance.
Maximizes the use of new technology to deliver products and services.
Identifies gaps between actual and needed technical competencies and provides recommendations for required training.
Uses technology in decision making and problem solving.
Supports employee training and development initiatives regarding implementation of technology.
Excellence	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Keeps themselves and others focused on constant improvement.
Takes a lot of pride in their work.
Produces high quality work.
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
Creates accurate and effective measures of safety.
Develops safety guidelines for the department.
Mitigates hazards and safety issues that arise.
Seeks to reduce the likelihood of accidents.
Supports our company's safety programs.
Trustworthy	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Takes care to maintain confidential information.
Is trustworthy; is someone I can trust.
Is a person you can trust.
Works in a way that makes others want to work with her/him.
Seeks to mitigate grievances by clarifying intentions and finding suitable remedies.
Responsible	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Holds herself / himself accountable to goals / objectives
...takes personal responsibility for results.
Sets a good example
Sets high personal standards of performance.
Behavior is ethical and honest.
Developing Others	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Develops employees by offering and encouraging them to take on new or additional responsibilities.
Recognizes and celebrates accomplishments of others.
Tries to ensure employees are ready to move to the next level.
Is open to receiving feedback.
Assesses employees' developmental needs.
Planning	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Anticipates potential challenges, develops plan to overcome them and then carries out the plan.
Works in an organized manner
Makes plans and follows through.
Delegates role to team members to accomplish goals.
Able to look ahead (beyond the present) when addressing the work/needs of the department.

56. Overall, please rate the effectiveness of .
    

    5- Very Effective 4- Effective 3- Neither 2- Ineffective 1- Very Ineffective

    
    
57. Strengths
    
    
    
58. Areas for Development
    
    
    
59. Please give any final comments or suggestions for 's assessment.