Coworker Development - 360 Degree Feedback Survey Sample #12

360 Feedback Survey

Instructions

We appreciate you taking the time to provide valuable feedback for the individual mentioned above. As you respond, please draw on your first-hand experience with this individual in the past 12 months. Your insights are crucial in offering a comprehensive evaluation. Please rate each item using the scale provided. If you find that you do not have sufficient first-hand knowledge to rate a particular item, select the Not Applicable option.

In addition to the ratings, we encourage you to include comments where possible. These comments are particularly useful when you give a very high or very low rating, as they provide context and clarity regarding your assessment. Explaining your reasons in the comment section helps ensure that your feedback is constructive and actionable.

Your responses, combined with feedback from other contributors, will be compiled and presented to the individual. This collective feedback aims to support their continuous growth and development by highlighting strengths and identifying areas for improvement. Your thoughtful participation is essential in helping them achieve their full potential.

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.

To what extent does [Participant Name] exhibit the following ...

SELECT the rating that best reflects the employee's performance in the areas listed.

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Co-worker Development

• Sets and clearly communicates expectations, performance goals, and measurements to others
• Provides ongoing feedback to co-workers on their development progress
• Gives others development opportunities through project assignments and increased job responsibilities
• Adapts coaching and mentoring approach to meet the style or needs of individuals
• Works to identify root causes of performance problems

Needs Improvement		Fully Proficient		Excels/ Role Model
Click this box to make your rating

Comments:

Emotional Intelligence

• Is able to express themselves clearly.
• Is able to manage their own emotions.
• Helps employees to resolve conflicts, communicate clearly, and work together to solve problems.
• Able to understand others' points of view.
• Helps to make decisions and solve problems using knowledge about how others will react in certain situations.

Needs Improvement		Fully Proficient		Excels/ Role Model
Click this box to make your rating

Comments:

Quality

• Promotes quality improvement practices in the department.
• Is flexible in addressing issues related to quality.
• Assesses strengths and weaknesses of various quality initiatives.
• Influences others to achieve high quality standards.
• Competently and accurately analyzes quality measures.

Needs Improvement		Fully Proficient		Excels/ Role Model
Click this box to make your rating

Comments:

Achievement

• Makes a plan for getting things done and drives execution of the strategic plan, actively supporting or leading initiatives to closure.
• Highly motivated to achieve or exceed performance standards.
• Strives to exceed standards of performance.
• Is results oriented.
• Driven to complete assignments on time.

Needs Improvement		Fully Proficient		Excels/ Role Model
Click this box to make your rating

Comments:

Trustworthy

• Communicates an understanding of the other person's interests, needs and concerns.
• Is trustworthy; is someone I can trust.
• Takes care to maintain confidential information.
• Works in a way that makes others want to work with her/him.
• Delivers on promises made.

Needs Improvement		Fully Proficient		Excels/ Role Model
Click this box to make your rating

Comments:

Strengths


Areas for Development


Please give any final comments or suggestions for [Participant Name Here]'s assessment.