Empowering Others- 360 Degree Feedback Survey Sample #1





360-Degree Feedback Survey

Questionnaires Measuring Empowering Others:
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:
Empowering Others, Excellence, Integrity, Professional Development, Administrative Skill, Innovation, Commitment To Result, Safety, Trustworthy, Planning
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


Empowering Others

Needs
Improvement
Meets
Minimum
Standards
Is
Proficient
Role
Model
  1. Allows employees to make their own decisions.
  1. Includes others in the decision making process.
  1. Encourages employees to solve problems on their own.
  1. Allows the employees to have flexible work schedules.
  1. Encourages employees to make informed decisions based on their own judgment and reasoning.
If [Participant Name] were to make improvements in Empowering Others, what are your suggestions for how he/she can improve this?

Excellence

Needs
Improvement
Meets
Minimum
Standards
Is
Proficient
Role
Model
  1. Takes a lot of pride in their work.
  1. Produces high quality work.
  1. Can be counted on to add value wherever they are involved.
  1. Demonstrates the analytical skills to do their job.
  1. Demonstrates the functional or technical skills necessary to do their job.
If [Participant Name] were to make improvements in Excellence, what are your suggestions for how he/she can improve this?

Integrity

Needs
Improvement
Meets
Minimum
Standards
Is
Proficient
Role
Model
  1. Maintains strong relationships with others.
  1. Establishes relationships of trust, honesty, fairness, and integrity.
  1. Demonstrates sincerity in actions with others.
  1. Fosters an environment built upon trust.
  1. Does what was promised.
If [Participant Name] were to make improvements in Integrity, what are your suggestions for how he/she can improve this?

Professional Development

Needs
Improvement
Meets
Minimum
Standards
Is
Proficient
Role
Model
  1. Encourages employees to take courses relevant to their job.
  1. Seeks opportunities for continuous learning.
  1. Contributing fully to the extent of their skills
  1. Keep themselves up-to-date of technical/professional issues
  1. Seeks opportunities for professional development.
If [Participant Name] were to make improvements in Professional Development, what are your suggestions for how he/she can improve this?

Administrative Skill

Needs
Improvement
Meets
Minimum
Standards
Is
Proficient
Role
Model
  1. Implements and uses performance measures.
  1. Takes responsibility for decisions.
  1. Accurately implements contract provisions.
  1. Has strong technical/computer skills.
  1. Able to develop, justify and present a budget.
If [Participant Name] were to make improvements in Administrative Skill, what are your suggestions for how he/she can improve this?

Innovation

Needs
Improvement
Meets
Minimum
Standards
Is
Proficient
Role
Model
  1. Encourages open communication to ensure that all proposals are considered.
  1. Searches for opportunities and innovative ways to improve the organization.
  1. Develops new products and services.
  1. Implements best practices within the department.
  1. Offers constructive improvements to existing systems.
If [Participant Name] were to make improvements in Innovation, what are your suggestions for how he/she can improve this?

Commitment To Result

Needs
Improvement
Meets
Minimum
Standards
Is
Proficient
Role
Model
  1. Able to focus on a task even when working alone.
  1. Coordinates all department activities into a cohesive team effort.
  1. Encourages commitment in others to obtain results.
  1. Creates a sense of urgency among the store team members to complete activities, which drive sales.
  1. Committed to the team.
If [Participant Name] were to make improvements in Commitment To Result, what are your suggestions for how he/she can improve this?

Safety

Needs
Improvement
Meets
Minimum
Standards
Is
Proficient
Role
Model
  1. Develops safety guidelines for the department.
  1. Is aware of OSHA safety guidelines.
  1. Develops a culture of safety.
  1. Seeks to reduce the likelihood of accidents.
  1. Encourages others to work safely.
If [Participant Name] were to make improvements in Safety, what are your suggestions for how he/she can improve this?

Trustworthy

Needs
Improvement
Meets
Minimum
Standards
Is
Proficient
Role
Model
  1. Is trustworthy; is someone I can trust.
  1. Works in a way that makes others want to work with her/him.
  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. Delivers on promises made.
If [Participant Name] were to make improvements in Trustworthy, what are your suggestions for how he/she can improve this?

Planning

Needs
Improvement
Meets
Minimum
Standards
Is
Proficient
Role
Model
  1. Determines staffing needs for the project/department.
  1. Identifies resource requirements that may impact the development of the 5-year plan.
  1. Establishes and monitors timeframes and timelines.
  1. Understands what equipment will be needed for the project.
  1. Able to stay organized and focused using excellent planning skills.
If [Participant Name] were to make improvements in Planning, 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.