Coworker Development - 360 Degree Feedback Survey Sample #12

360 Feedback Survey

Instructions

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 comment section for that competency. 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.

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

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

Co-worker Development

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

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

Comments:

Emotional Intelligence

• Helps employees to resolve conflicts, communicate clearly, and work together to solve problems.
• Is able to control their own emotions.
• Is attentive to emotional cues and interprets others' feelings correctly.
• Helps to make decisions and solve problems using knowledge about how others will react in certain situations.
• Accurately perceives the emotional reactions of others.

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

Comments:

Quality

• Promotes quality improvement practices in the department.
• Influences others to achieve high quality standards.
• Designs effective quality control systems.
• Evaluates and improves the quality of services and products.
• Consistently provides timely, accurate, and reliable information on quality measures.

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

Comments:

Achievement

• Completed training on the new equipment.
• Makes a plan for getting things done and drives execution of the strategic plan, actively supporting or leading initiatives to closure.
• Eliminates bureaucratic barriers to streamline processes.
• Completed required training and certification.
• Strives to meet goals and objectives.

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 a person you can trust.
• Seeks to mitigate grievances by clarifying intentions and finding suitable remedies.
• Takes ownership, delivers on commitments
• Builds and maintains the trust of others.

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.