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Engagement- 360 Degree Feedback Survey Sample #1





360-Degree Feedback Survey

Surveys Measuring Engagement:
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)
Survey 13 (4-point scale; numbers; floating anchors)
Survey 14 (4-point scale; N/A)
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:
Engagement, Communication Skills, Empowering Others, Others, Self Management, Project Management, Initiative, Safety, 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
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Engagement

Needs
Improvement
Meets
Minimum
Standards
Is
Proficient
Role
Model
  1. Supports career development and progression.
  1. Values employee opinions and suggestions.
  1. Is dedicated to building strong connections with colleagues and contributing to high-quality work.
  1. Gives feedback that strengthens employee skills and confidence.
  1. Gives employees opportunities to provide input and influence policies and practices that affect my job.
If [Participant Name] were to make improvements in Engagement, what are your suggestions for how he/she can improve this?

Communication Skills

Needs
Improvement
Meets
Minimum
Standards
Is
Proficient
Role
Model
  1. Faces the person when speaking or listening to engage in direct communication.
  1. Open to receiving feedback from others.
  1. Adapts language and terminology to meet the needs of the audience.
  1. Clarifies problems logically, simplifying complex matters into digestible parts.
  1. Mentors others on enhancing their written communication.
If [Participant Name] were to make improvements in Communication Skills, what are your suggestions for how he/she can improve this?

Empowering Others

Needs
Improvement
Meets
Minimum
Standards
Is
Proficient
Role
Model
  1. Enables team members to make their own decisions on the project.
  1. Recognizes the importance of a healthy work/life balance.
  1. Delegates meaningful responsibilities that signal trust and confidence.
  1. Fosters a sense of ownership and accountability for the process/product.
  1. Allows subordinates to perform mission critical tasks.
If [Participant Name] were to make improvements in Empowering Others, what are your suggestions for how he/she can improve this?

Others

Needs
Improvement
Meets
Minimum
Standards
Is
Proficient
Role
Model
  1. Forms working relationships with employees from other departments.
  1. Includes others in the decision making processes.
  1. Able to see issues from others' perspectives.
  1. Helpful
  1. Works effectively with people from other departments.
If [Participant Name] were to make improvements in Others, what are your suggestions for how he/she can improve this?

Self Management

Needs
Improvement
Meets
Minimum
Standards
Is
Proficient
Role
Model
  1. Analyzes own reactions on the spot to ensure that communication does not appear to be driven by anger.
  1. Analyzes interpersonal problems instead of reacting to them.
  1. Steps away from a situation to process appropriate response.
  1. Sets an example for associates during stressful periods by maintaining a positive, can-do attitude.
  1. Uses patience and self-control in working with customers and associates.
If [Participant Name] were to make improvements in Self Management, what are your suggestions for how he/she can improve this?

Project Management

Needs
Improvement
Meets
Minimum
Standards
Is
Proficient
Role
Model
  1. Estimates the time needed for each phase of the project.
  1. Creates a schedule for the different phases of the project.
  1. Ensures that the project remains at or under budget.
  1. Coordinates timelines, events and tasks with various sub-groups within the project.
  1. Communicates the results of the project, at the conclusion, to all stakeholders.
If [Participant Name] were to make improvements in Project Management, what are your suggestions for how he/she can improve this?

Initiative

Needs
Improvement
Meets
Minimum
Standards
Is
Proficient
Role
Model
  1. Takes decisive action to address problems, following up with relevant team members and coaching them on how to improve.
  1. Expands the offerings of the department by working evenings and weekends.
  1. Immediately informs the HR Department of any personnel complaints or issues.
  1. Acts with urgency when time is of the essence.
  1. Proactively identifies and removes barriers that inhibit progress without waiting for direction.
If [Participant Name] were to make improvements in Initiative, what are your suggestions for how he/she can improve this?

Safety

Needs
Improvement
Meets
Minimum
Standards
Is
Proficient
Role
Model
  1. Seeks to reduce the likelihood of accidents.
  1. Points out behaviors in others that may be unsafe.
  1. Develops safety guidelines for the department.
  1. Ensures that all supervisors are aware of regulatory and compliance measures.
  1. Mitigates hazards and safety issues that arise.
If [Participant Name] were to make improvements in Safety, what are your suggestions for how he/she can improve this?

Planning

Needs
Improvement
Meets
Minimum
Standards
Is
Proficient
Role
Model
  1. Accurately estimates the amount of materials/supplies needed for the project.
  1. Ensures staff have the supplies and resources necessary to enact the plan.
  1. Develops plans used to accomplish urgent or critical tasks.
  1. Conducts regular assessments of the project status to ensure adherence to the set schedule.
  1. Has plans to handle unexpected events.
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.