Creativity - 360 Degree Feedback Survey Sample #6

360-Degree Assessment Survey

Dear Employee:

You have been selected to participate in a 360-assessment. As part of this process you will need to complete the self-assessment questionnaire below.

In responding to the questions below, think about your experiences over the last 12 months. The effectiveness of this development tool is dependent on your honest, forthright and constructive responses so please bear this in mind as you answer each question. Your responses will be aggregated with the responses received from others. A report will be shared with you at the conclusion of this project.

We encourage everyone to complete the survey. Please be honest, constructive and thoughtful in your input. The survey is designed to help us understand more about your thoughts and needs to make this a great company.

The results of this survey will be used to help drive our future success. We will report back to you about what you have said and what we plan to do about it. 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

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Creativity	Needs Significant Improvement	Could benefit from Development	Capable and Effective	Role Model
You ask others to create new solutions to existing problems.
You find creative ways to meet the needs of patients.
You allow the department to implement creative ideas.
I create an environment that supports creativity and innovation.
You introduce tools and frameworks that support creative thinking.
Passion To Learn	Needs Significant Improvement	Could benefit from Development	Capable and Effective	Role Model
You enjoy learning new skills and techniques.
You will participate in training classes even if offered outside of normal working hours.
You exhibit willingness to upgrade skills through additional training and education.
You stay up-to-date on emerging technologies.
You constantly enhance product knowledge through experimentation and play.
Professional Development	Needs Significant Improvement	Could benefit from Development	Capable and Effective	Role Model
You encourage employees to take courses relevant to their job.
You are contributing fully to the extent of your skills
You seek opportunities for professional development.
You keep yourself up-to-date of technical/professional issues
You seek opportunities for continuous learning.
Persuasion and Influence	Needs Significant Improvement	Could benefit from Development	Capable and Effective	Role Model
You get employees to change the way they process inputs.
You identify key stakeholders and solicit them for their help.
I successfully wield influence over others.
I use logic and reason to persuade and influence others.
You use public methods of communication to impact the greatest number of individuals.
Innovation	Needs Significant Improvement	Could benefit from Development	Capable and Effective	Role Model
I focus the team on important innovations.
You create innovative products or services.
You champion disruptive innovations to open new market opportunities and redefine industry standards.
You help focus the department on innovation.
I transform raw ideas into actionable plans with a higher likelihood of successful implementation.
Achievement	Needs Significant Improvement	Could benefit from Development	Capable and Effective	Role Model
I operate with relentless drive, consistently meeting and surpassing deadlines.
I prioritize time management and coordination, ensure high-value tasks are address efficiently.
You strive to exceed standards of performance.
You are flexible in adjusting priorities to meet the demands of changing situations.
You establish stretch goals to advance skills and output.
Managing Risk	Needs Significant Improvement	Could benefit from Development	Capable and Effective	Role Model
You accurately perceive potential risks in the workplace and initiates preventative measures.
I understand how to meet regulatory compliance.
I take calculated risks by effectively recognizing and managing them.
You align risk management activities with existing processes.
I conduct regular audits of the risk management framework.
Planning	Needs Significant Improvement	Could benefit from Development	Capable and Effective	Role Model
You develop proper plans to ensure seamless flow of materials through logistics.
You delegate role to team members to accomplish goals.
You are able to clearly articulate the plan for the department/district.
You establish a course of action for self and others to accomplish specific goals.
You ensure staff are held accountable for following the department plan.

41. Overall, please rate the effectiveness of [Participant Name Here].
    

    5- Very Effective 4- Effective 3- Neither 2- Ineffective 1- Very Ineffective

    
    
42. Describe the greatest strengths of this person with regard to his/her overall effectiveness in performing his/her current responsibilities.
    
    
    
43. Describe the most important things this person could improve upon in order to increase his/her overall effectiveness in performing his/her current responsibilities.
    
    
    
44. Additional comments, if any for [Participant Name Here]'s assessment.