Communication - 360 Degree Feedback Survey Sample #4

Dear Employee:

Welcome to our 360-Degree Feedback self-assessment questionnaire. Our objective is to provide feedback which will help advance your leadership skills and capabilities. We are asking you to take time to respond to this survey to help us identify areas where you are doing well and where you have opportunities to do better. Others will also complete the questionnaire to provide you with feedback.

We have developed this survey with questions tailored for your position in the department to provide you with an opportunity to rate many facets of your leadership performance.

Please be honest, constructive and thoughtful in your responses. The results of this survey will be used to help drive our future success. If you have any questions about the process please contact [Contact Person].

Please ensure that your submission is made between . The survey will only be available during these dates.

Thank you for your participation in the survey. We look forward to seeing the analysis of your responses and we are hoping for 100% participation.

Management Team



Instructions:
Please complete the items below and press the submit button at the end of the survey. If you need multiple sessions to complete the survey, please click the "Submit" button at the end of each session to save your responses. Please feel free to skip any items that you do not wish to respond to. Keep in mind that your responses help us to become a better place to work. So, you are encouraged to respond to all items on the questionnaire.

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Communication Skills	Needs Significant Development 1	2	Capable and Effective 3	4	Role Model 5
You give clear and convincing presentations.
I update others on changes or progress in plans and goals.
You overcome barriers that prevent effective communication.
I maintain an open-door policy to be available for answers and guidance when needed.
You are able to deliver presentations.
Adaptability	Needs Significant Development 1	2	Capable and Effective 3	4	Role Model 5
You adjust priorities to changing business goals.
You are open to changes in policies and procedures.
You are open to change and adjusts plans when needed.
You adjust plans to meet the needs of new constraints.
You are able to recognize the potential benefits of change, and create an infrastructure which supports change.
Cultural Awareness	Needs Significant Development 1	2	Capable and Effective 3	4	Role Model 5
You foster a diverse workforce free from discrimination and harassment.
You understand what customs and etiquette are important for individuals from other cultures.
You respect others regardless of age, race, gender, nationality, or disability.
You are aware of the similarities and differences among and between cultural groups.
You are open to learning about different cultures.
Leadership	Needs Significant Development 1	2	Capable and Effective 3	4	Role Model 5
You are able to organize the work of others.
You guide decision-making by coaching, counseling and rewarding.
You set clear goals and objectives for subordinates.
You take ownership and accountability for results
You demonstrate leadership and courage in critical situations.
Delegation	Needs Significant Development 1	2	Capable and Effective 3	4	Role Model 5
You entrust subordinates with important tasks.
You clearly define duties and tasks to be completed.
You encourage and empower subordinates to use initiative in achieving goals and objectives.
You set clear and reasonable expectations for others and follow through on their progress.
You define goals and objectives for subordinates.
Innovation	Needs Significant Development 1	2	Capable and Effective 3	4	Role Model 5
You challenge current procedures to develop other alternatives.
You create improved methods or solutions for meeting goals and objectives.
You encourage open communication to ensure that all proposals are considered.
You solve problems with insight and understanding.
You suggest new ideas at meetings.
Results Oriented	Needs Significant Development 1	2	Capable and Effective 3	4	Role Model 5
You are willing to take on new assignments to help increase production.
You determine the parts of the project that need completed first.
I achieve performance benchmarks.
You set a common goals for the team.
I determine the objectives for the project.
Safety	Needs Significant Development 1	2	Capable and Effective 3	4	Role Model 5
You are aware of osha safety guidelines.
You develop a culture of safety.
You ensure compliance with safety regulations.
You participate in safety training when available.
You keep accurate safety records.
Responsible	Needs Significant Development 1	2	Capable and Effective 3	4	Role Model 5
You are responsible for setting the vision of the department.
You set a good example
You work in a way that makes others want to work with you.
You are a person others can trust.
Your behavior is ethical and honest.
Regulatory/Compliance	Needs Significant Development 1	2	Capable and Effective 3	4	Role Model 5
You explain regulations and procedures to others as required.
I investigate risk mitigation strategies.
You implement regulatory changes in a timely manner.
I establish clear communication channels and lines of communication for compliance related issues.
You comply with regulatory requirements for the state.

51. On a scale of Excellent to Poor, how would you rate your overall employment with [Company] and why?
    

    -Excellent -Good -Average -Poor




52. Would you refer others who are seeking employment to [Company]?
    Yes No
    
    Please provide explanation:
    
    
    
53. If you had an opportunity to make any change you wanted to make [Company] a better place to work, what one improvement would you make?
    
    
    
54. What changes do you see [Company] making in order to raise the standards?
    
    
    
55. I feel good about my continued employment with [Company].
    Yes No
    
    If no, please provide explanation:
    
    
    
56. What do you like best about working for [Company]?
    
    
    
57. What do you like least about working for [Company]? How could it be improved?
    
    
    
93. Use the space below to enter any final comments you would like to be noted: