Customer Focus- 360 Degree Feedback Survey Sample #1





360-Degree Feedback Survey

Questionnaires Measuring Responsibility:
Survey 1 (4-point scale; Competency Comments)
Survey 2 (4-point scale; Competency Comments)
Survey 3 (5-point scale; Competency Comments)
Survey 4 (5-point scale; radio buttons)
Survey 5 (4-point scale; words)
Survey 6 (4-point scale; words)
Survey 7 (5-point scale; competency comments; N/A)
Survey 8 (3-point scale; Agree/Disagree words; N/A)
Survey 9 (3-point scale; Strength/Development; N/A)
Survey 10 (Comment boxes only)
Survey 11 (Single rating per competency)
Survey 12 (Slide-bar scale)
Instructions:

[Company] is conducting a 360-Degree Feedback Assessment developed by HR-Survey for selected managers.

You have been selected to provide feedback on the employee listed above. Your feedback is an important part of our company's leadership development process and this survey is intended to gather broad feedback in the core competencies and role responsibilities that are important for the on-going success of our organization.

In responding to the questions below, think about your experiences working with this employee over the last twelve 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 and discussed with the employee to foster growth and on-going 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.

Competencies Included:
Customer Focus, Performance, Achievement, Action, Leadership, Management, Co-worker Development, Entrepreneurship, Trustworthy
Sample Result Document:
Sample Results
Your feedback is valuable in helping the individual to understand how they are perceived and experienced by others and the impact their behavior has on people in the organization with whom they interact. Feedback received also acknowledges strengths and identifies areas for development.

Use the form below to provide your feedback. Each field and comment box requires a response before you can SUBMIT your final feedback.

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


Customer Focus

Needs
Improvement
Meets
Minimum
Standards
Is
Proficient
Role
Model
  1. Is pro-active in dealing with customers and addressing their needs.
  1. Follows up with any unanswered questions from the customer.
  1. Makes sure team members understand the issues faced by the customer.
  1. Sets an example for excellent customer relations.
  1. Provides training to others on how to improve customer service.
If [Participant Name] were to make improvements in Customer Focus, what are your suggestions for how he/she can improve this?

Performance

Needs
Improvement
Meets
Minimum
Standards
Is
Proficient
Role
Model
  1. Effective in performing his/her job.
  1. ...Overall Performance
  1. Able to organize work.
  1. Sets a high standard for job performance.
  1. Has great overall performance
If [Participant Name] were to make improvements in Performance, what are your suggestions for how he/she can improve this?

Achievement

Needs
Improvement
Meets
Minimum
Standards
Is
Proficient
Role
Model
  1. Successfully launched the ABC project.
  1. Sets performance metrics to measure achievement or attainment of goals.
  1. Increased customer satisfaction scores for the quarter.
  1. Demonstrates a sense of urgency to quickly and accurately solve problems and issues.
  1. Improved the quality of work on the production line.
If [Participant Name] were to make improvements in Achievement, what are your suggestions for how he/she can improve this?

Action

Needs
Improvement
Meets
Minimum
Standards
Is
Proficient
Role
Model
  1. Is not afraid to take corrective action when necessary.
  1. Takes action in critical situations.
  1. Sets high standards for themselves and others.
  1. Moves forward on important projects.
  1. Is the first to volunteer for assignments.
If [Participant Name] were to make improvements in Action, what are your suggestions for how he/she can improve this?

Leadership

Needs
Improvement
Meets
Minimum
Standards
Is
Proficient
Role
Model
  1. Gives inspiring presentations or discussions.
  1. Expresses clear goals and objectives.
  1. Highly effective supervisor.
  1. Takes ownership and accountability for results
  1. Able to organize the work of others.
If [Participant Name] were to make improvements in Leadership, what are your suggestions for how he/she can improve this?

Management

Needs
Improvement
Meets
Minimum
Standards
Is
Proficient
Role
Model
  1. Is ready to offer help
  1. Sets an example for others to follow
  1. Makes you feel enthusiastic about your work
  1. Keep staff informed about what is happening in the company
  1. Delegate tasks effectively
If [Participant Name] were to make improvements in Management, what are your suggestions for how he/she can improve this?

Co-worker Development

Needs
Improvement
Meets
Minimum
Standards
Is
Proficient
Role
Model
  1. Gives others development opportunities through project assignments and increased job responsibilities
  1. Provides ongoing feedback to co-workers on their development progress
  1. Sets and clearly communicates expectations, performance goals, and measurements to others
  1. Works to identify root causes of performance problems
  1. Adapts coaching and mentoring approach to meet the style or needs of individuals
If [Participant Name] were to make improvements in Co-worker Development, what are your suggestions for how he/she can improve this?

Entrepreneurship

Needs
Improvement
Meets
Minimum
Standards
Is
Proficient
Role
Model
  1. Able to adapt the department to changing business demands and climate.
  1. Encourages risk taking for developing potential business opportunities.
  1. Seeks and utilizes mentors to help guide professional development.
  1. Finds unique ways to go around barriers to success.
  1. Exhibits determination and passion in completion of goals.
If [Participant Name] were to make improvements in Entrepreneurship, what are your suggestions for how he/she can improve this?

Trustworthy

Needs
Improvement
Meets
Minimum
Standards
Is
Proficient
Role
Model
  1. Builds and maintains the trust of others.
  1. Seeks to mitigate grievances by clarifying intentions and finding suitable remedies.
  1. Communicates an understanding of the other person's interests, needs and concerns.
  1. Demonstrates a sense of responsibility and commitment to public trust.
  1. Delivers on promises made.
If [Participant Name] were to make improvements in Trustworthy, what are your suggestions for how he/she can improve this?

  1. What are [Participant Name Here]'s greatest strengths demonstrated this year?


  2. What are [Participant Name Here]'s areas for development?


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