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

• Takes immediate action on poor performance
• Adapts coaching and mentoring approach to meet the style or needs of individuals
• Sets and clearly communicates expectations, performance goals, and measurements to others
• Works to identify root causes of performance problems
• 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

• Is attentive to emotional cues and interprets others' feelings correctly.
• Is able to control their own emotions.
• Helps employees to resolve conflicts, communicate clearly, and work together to solve problems.
• Is able to manage their own emotions.
• Is able to express themselves clearly.

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

Comments:

Quality

• Holds employees accountable for their quality of work.
• Reflects on what is working and what could be improved.
• Encourages others to produce the highest quality work products.
• Corrects issues in a timely manner.
• Encourages employees to produce the best quality products.

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

Comments:

Achievement

• Establishes Specific Measurable Achievable Realistic and Timed (SMART) goals.
• Successfully completed the orientation training program.
• Demonstrates a sense of urgency to quickly and accurately solve problems and issues.
• Works at a quick pace to complete a high volume of work.
• Completed required training and certification.

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

Comments:

Trustworthy

• Takes ownership, delivers on commitments
• Works in a way that makes others want to work with her/him.
• Demonstrates a sense of responsibility and commitment to public trust.
• Is trustworthy; is someone I can trust.
• Seeks to mitigate grievances by clarifying intentions and finding suitable remedies.

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.