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
I keep my supervisor informed about achievements and milestones.
I provide feedback in a helpful and respectful way, focusing on improvement.
I welcome input and suggestions from others.
I ensure comprehension during conversations or group presentations.
You deliver effective public presentations.
Adaptability	Needs Significant Development 1	2	Capable and Effective 3	4	Role Model 5
You are able to adjust to changes as needed.
You can adjust tactics and strategies.
You work effectively in dynamic and changing work environments.
I embrace change and foster an open-minded environment.
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
I recognize individual and cultural differences.
You hire individuals with different cultural backgrounds for the department.
I interact effectively with people from different cultural backgrounds.
You support and mentor others that may have different cultural backgrounds.
I actively listen to other employees' stories about their culture.
Leadership	Needs Significant Development 1	2	Capable and Effective 3	4	Role Model 5
You hold others accountable for your actions.
You recognize individual and team accomplishments and reward them appropriately.
You lead team to set goals, solve problems, and accomplish tasks.
You are able to organize the work of others.
You give inspiring presentations or discussions.
Delegation	Needs Significant Development 1	2	Capable and Effective 3	4	Role Model 5
You define the roles, responsibilities, required actions, and deadlines for team members.
You clearly define duties and tasks to be completed.
You assign tasks to create learning opportunities for the employees.
You delegate tasks, responsibilities, and accountability as appropriate to the level of employee.
You define goals and objectives for subordinates.
Innovation	Needs Significant Development 1	2	Capable and Effective 3	4	Role Model 5
You create new products or services.
You establish systems of continuous improvement.
You generate innovative and practical solutions.
You develop effective solutions for viewing problems from a different point of view.
I understand that innovation requires doing things differently.
Results Oriented	Needs Significant Development 1	2	Capable and Effective 3	4	Role Model 5
You explain the "whys" behind organizational objectives
You demonstrate the personal confidence to "stay the course," even when faced with difficulty
I set benchmarks and milestones to measure progress toward the objectives.
Completed work exceeds standards.
I identify what needs to be accomplished.
Safety	Needs Significant Development 1	2	Capable and Effective 3	4	Role Model 5
You create accurate and effective measures of safety.
You keep accurate safety records.
You develop a culture of safety.
You identify predictable hazards in the workplace.
You support safety programs and procedures.
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 take personal responsibility for results.
You complete assigned work tasks.
You set a good example
You are a person others can trust.
Regulatory/Compliance	Needs Significant Development 1	2	Capable and Effective 3	4	Role Model 5
You are familiar with EEOC, FLSA, OSHA and ERISA acts/standards.
You keep up-to-date with legislation affecting employees.
I review documentation and procedures manuals to ensure regulatory compliance.
I create a company compliance manual for distribution to the employees.
I create and implement training courses for new hires to ensure knowledge of regulations and policies.

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: