Feedback - 360 Degree Feedback Survey Sample #4

Dear Employee:

Welcome to our 360-Degree Feedback self-assessment questionnaire. Our objective is to provide feedback which will help advance your leadership skills and capabilities. We are asking you to take time to respond to this survey to help us identify areas where you are doing well and where you have opportunities to do better. Others will also complete the questionnaire to provide you with feedback.

We have developed this survey with questions tailored for your position in the department to provide you with an opportunity to rate many facets of your leadership performance.

Please be honest, constructive and thoughtful in your responses. The results of this survey will be used to help drive our future success. 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

Instructions:
Please complete the items below and press the submit button at the end of the survey. If you need multiple sessions to complete the survey, please click the "Submit" button at the end of each session to save your responses. Please feel free to skip any items that you do not wish to respond to. Keep in mind that your responses help us to become a better place to work. So, you are encouraged to respond to all items on the questionnaire.

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Feedback	Needs Significant Development 1	2	Capable and Effective 3	4	Role Model 5
You accept the views of others.
You are easy to approach with ideas and opinions.
You are visible and approachable.
You share past experiences with others as learning opportunities.
You consider other's opinion and suggestions.
Performance	Needs Significant Development 1	2	Capable and Effective 3	4	Role Model 5
You set a high standard for job performance.
You work well in this position.
You produce quality
You are able to organize work.
You effectively organize resources and plans
Flexibility	Needs Significant Development 1	2	Capable and Effective 3	4	Role Model 5
You are willing to try new ideas.
You adapt to circumstances as needed.
You can handle changes without complaining.
You implement changes as a result of having listened to employees
You are open to alternative ways to accomplish goals
Adaptability	Needs Significant Development 1	2	Capable and Effective 3	4	Role Model 5
You adjust priorities to changing business goals.
You easily accept new responsibilities.
You adapt to diversity within the team.
You adjust strategy when new information is presented.
You develop insights and apply innovative solutions to projects and problems.
Bias for Action	Needs Significant Development 1	2	Capable and Effective 3	4	Role Model 5
You project a "can-do" attitude when interfacing with peers, subordinates and customers(especially during difficult and challenging times).
You coach others to foster an environment which can adapt quickly and willingly to rapid change.
You complete work on time
You complete a large volume of work.
You motivate others to achieve or exceed goals
Problem Solving	Needs Significant Development 1	2	Capable and Effective 3	4	Role Model 5
You work cooperatively with others to solve problems.
You identify fresh approaches and shows a willingness to question traditional assumptions.
You are able to balance the needs of different people in a solution to a problem.
You implement effective solutions to critical problems.
You solve problems using logic and insight.
Results Oriented	Needs Significant Development 1	2	Capable and Effective 3	4	Role Model 5
I set benchmarks and milestones to measure progress toward the objectives.
You keep track of progress toward the results.
You work toward achievement of goals even when confronted with obstacles.
I determine what resources will be needed to achieve the objectives.
I am flexible in adjusting priorities to meet the demands of changing situations.
Safety	Needs Significant Development 1	2	Capable and Effective 3	4	Role Model 5
You work to implement corrective safety measures.
You point out behaviors in others that may be unsafe.
You support our company's safety programs.
You identify predictable hazards in the workplace.
You keep accurate safety records.
Customer Focus	Needs Significant Development 1	2	Capable and Effective 3	4	Role Model 5
I create new and innovative products for customers.
You look for opportunities that have a positive impact on customers.
I regularly received positive feedback from customers.
I deliver customized solutions for each customer.
I identify the core needs of the customer.
Partnering/Networking	Needs Significant Development 1	2	Capable and Effective 3	4	Role Model 5
You forge mutually beneficial relationships between individuals with diverse backgrounds.
You seek to reduce institutional roadblocks to information sharing.
You capitalize on partnerships and networks to enhance the Company's bottom line.
You support and encourage relationships that are created by diverse team members.
You support a partnering/networking culture.
Conflict Management	Needs Significant Development 1	2	Capable and Effective 3	4	Role Model 5
You try to understand others' point of view before making judgments
You identify and takes steps to prevent potential confrontations.
You assist team members by helping them see the other point of view.
You discuss conflict situations with supervisor.
You deal effectively with employee grievances.

56. On a scale of Excellent to Poor, how would you rate your overall employment with [Company] and why?
    

    -Excellent -Good -Average -Poor




57. Would you refer others who are seeking employment to [Company]?
    Yes No
    
    Please provide explanation:
    
    


58. If you had an opportunity to make any change you wanted to make [Company] a better place to work, what one improvement would you make?
    
    
    


59. What changes do you see [Company] making in order to raise the standards?
    
    


60. I feel good about my continued employment with [Company].
    Yes No
    
    If no, please provide explanation:
    
    
    


61. What do you like best about working for [Company]?
    
    


62. What do you like least about working for [Company]? How could it be improved?
    


93. Use the space below to enter any final comments you would like to be noted: