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.

---

Communication Skills	Needs Significant Development 1	2	Capable and Effective 3	4	Role Model 5
You deal with difficult situations calmly and confidently.
You communicate with department leadership
You listen to others' points of view with an open mind
You deliver influential presentations.
You address issues of key importance to stakeholders.
Adaptability	Needs Significant Development 1	2	Capable and Effective 3	4	Role Model 5
You respond quickly to new information.
You can accommodate changes as needed.
You are aware of changes in the environment.
You adapt to diversity within the team.
You are able to step in and help co-workers when needed.
Cultural Awareness	Needs Significant Development 1	2	Capable and Effective 3	4	Role Model 5
I am an advocate for others with different cultural backgrounds.
You acknowledge your own biases in cultural interactions.
You respect others regardless of age, race, gender, nationality, or disability.
I value the diverse perspectives from others.
You maintain an inclusive work environment that maximizes the talents of others in achieving goals.
Leadership	Needs Significant Development 1	2	Capable and Effective 3	4	Role Model 5
You give inspiring presentations or discussions.
You lead team to set goals, solve problems, and accomplish tasks.
You clearly explain performance expectations and goals to be reached at the beginning of a project, then let others decide how to achieve the goal.
You provide resources to enable individuals to develop professionally.
You effectively lead others.
Delegation	Needs Significant Development 1	2	Capable and Effective 3	4	Role Model 5
You delegate tasks, responsibilities, and accountability as appropriate to the level of employee.
You define the roles, responsibilities, required actions, and deadlines for team members.
You delegate authority and responsibility to subordinates and holds them accountable for your actions.
You allow subordinates to use their own methods and procedures.
You allow employees to decide how they wish to complete the tasks.
Innovation	Needs Significant Development 1	2	Capable and Effective 3	4	Role Model 5
You develop new products and services.
You find creative ways to get things done with limited resources.
You build upon the ideas and solutions of others.
You create a safe environment for idea-sharing.
You search for opportunities and innovative ways to improve the organization.
Results Oriented	Needs Significant Development 1	2	Capable and Effective 3	4	Role Model 5
You direct team in prioritizing daily work activities
You work toward achievement of goals even when confronted with obstacles.
You stay focused on meeting the needs of customers.
You help others when free-time is available.
You explain the "whys" behind organizational objectives
Safety	Needs Significant Development 1	2	Capable and Effective 3	4	Role Model 5
You participate in safety training as applicable.
You support our company's safety programs.
You support safety programs and procedures.
You encourage others to attend safety training.
You ensure that all supervisors are aware of regulatory and compliance measures.
Responsible	Needs Significant Development 1	2	Capable and Effective 3	4	Role Model 5
You complete assigned work tasks.
You are a person others can trust.
You hold yourself accountable to goals / objectives
You act as a resource without removing individual responsibility.
You set a good example
Regulatory/Compliance	Needs Significant Development 1	2	Capable and Effective 3	4	Role Model 5
You are professional and courteous in interactions with auditors and regulators.
You create and maintain necessary regulatory documentation.
You offer training on various subjects to help ensure employees are aware of regulations.
You explain regulations and procedures to others as required.
You provide documents and reports as needed to maintain compliance with laws.

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: