Empowering Others- 360 Degree Feedback Survey Sample #5

360-Degree Assessment Survey

Dear Employee:

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 Closing Comments section. Your responses will be compiled with feedback from others and presented to the recipient to help guide their ongoing development.

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Thank you for your participation in the survey.

Management Team

Empowering Others	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Willing to share in the decision making process.
Encourages others to obtain necessary skills and training.
Gives employees the opportunity to make their own decisions at work.
Supports the decisions of others.
Encourages employees to solve problems on their own.
Communication Skills	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Asks follow-up questions as needed.
Chooses the communication medium (ie. email, voice mail, memo, project document) that reflects the needs of the content. (ie. urgency, confidentiality, content scope)
Communicates with department leadership
Listens to others' points of view with an open mind
An effective listener who is responsive to information needs.
Creativity	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Inspires creativity in their team.
Develops solutions to challenging problems.
Adds value to the department/organization.
Creates a lot of new ideas.
Is creative and inspirational.
Self Management	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Does not allow own emotions to interfere with the performance of others.
Sets an example for associates during stressful periods by maintaining a positive, can-do attitude.
Analyzes own reactions on the spot to ensure that communication does not appear to be driven by anger.
Consciously controls own negative emotions in order to keep team morale up.
Analyzes interpersonal problems instead of reacting to them.
Continual Improvement	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Searches for new methods, techniques, and processes that increase efficiency and reduce costs.
Looks for ways to expand and learn new job skills.
Open to the suggestions from others.
Looks for ways to improve work processes and procedures.
Looks for ways to expand current job responsibilities.
Establishing Focus/Direction	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Makes sure that employees understand and identify with the team's mission.
Stays focused even when under pressure and stress.
Aligns the department's goals with the goals of the organization.
Helps guide employees with prioritizing tasks.
Excellent at managing time.
Managing Risk	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Accurately perceives potential risks in the workplace.
Implements changes to reduce the chances of critical incidents in the future.
Develops policies for risk management.
Is concerned about process safety management.
Is aware of process safety management.
Conflict Management	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Deals effectively with employee grievances.
Helps employees to think through alternative ways to resolve conflict situations.
Tries to understand others' point of view before making judgments
Discusses conflict situations with supervisor.
Assists team members by helping them see the other point of view.
Company	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Understands the use of [Company] products and services.
Expresses loyalty and dedication to [Company] in interactions with others.
Understands the "basics" as to how [Company] functions/operates.
Follows existing procedures and processes.
Attends [Company] gatherings and social events.
Global Perspective	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Comfortable using teleconferencing equipment to facilitate meetings with others abroad.
Respects individual differences.
Has positive interactions with individuals from different cultures and backgrounds.
Creates an environment where individual differences are valued and supported.
Is aware of the culture, behaviors, identities and beliefs of others.

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

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

    
    
52. Strengths
    
    
    
53. Areas for Development
    
    
    
54. Please give any final comments or suggestions for [Participant Name Here]'s assessment.