Commitment to Result - 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

Commitment To Result	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Willing to do whatever it takes-not afraid to have to put in extra effort.
Able to focus on a task even when working alone.
Encourages commitment in others to obtain results.
Creates a sense of urgency among the store team members to complete activities, which drive sales.
Committed to the team.
Co-worker Development	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Adapts coaching and mentoring approach to meet the style or needs of individuals
Gives others development opportunities through project assignments and increased job responsibilities
Works to identify root causes of performance problems
Provides ongoing feedback to co-workers on their development progress
Takes immediate action on poor performance
Passion To Learn	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Exhibits willingness to upgrade skills through additional training and education.
Is open to feedback from others.
Embraces new technology and procedures.
Is open minded and curious about learning new skills.
Recognizes own areas for development and consciously seeks assignments that will provide practice in areas of developmental need.
Others	Role Model	Capable and Effective	Somewhat Effective	Needs Development
...treats others with respect and dignity.
Supports the efforts of other employees in implementing solutions to problems.
Respects the opinions of other employees.
Consistently demonstrates ability and willingness to trust others.
Is able to see issues from others' perspectives.
Vision	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Creates a common vision for others.
Clearly articulates a vision for his/her work and inspires others to support it
Persuades others to follow the Company's vision.
Leads employees in new directions.
Demonstrates consistency between words and actions

26. Overall, please rate the effectiveness of [Participant Name Here].
    

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

    
    
27. Strengths
    
    
    
28. Areas for Development
    
    
    
29. Please give any final comments or suggestions for [Participant Name Here]'s assessment.