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 are visible and approachable.
You are easy to approach with ideas and opinions.
You are open to the suggestions of others.
You look to others for input.
You share past experiences with others as learning opportunities.
Performance	Needs Significant Development 1	2	Capable and Effective 3	4	Role Model 5
You work effectively in the department.
You have great overall performance
You are effective in performing your job.
You effectively organize resources and plans
You produce quality
Flexibility	Needs Significant Development 1	2	Capable and Effective 3	4	Role Model 5
You are willing to try new ideas.
You act decisively in frequently changing and uncertain environment.
You can handle changes without complaining.
You adapt to circumstances as needed.
You adapt to new organizational structures, policies, or procedures.
Adaptability	Needs Significant Development 1	2	Capable and Effective 3	4	Role Model 5
You are able to recognize the potential benefits of change, and create an infrastructure which supports change.
You perform a wide range of tasks, respond to changes in direction and priorities and accept new challenges, responsibilities, and assignments.
You are flexible and open to new ideas and encourages others to value change.
You recognize and implement changes to enhance efficiency and effectiveness.
You are willing to change ideas or perceptions based on new information or contrary evidence which is presented.
Bias for Action	Needs Significant Development 1	2	Capable and Effective 3	4	Role Model 5
You convey a sense of urgency about addressing problems and opportunities
You encourage risk taking and experimentation to improve performance
You display high energy and enthusiasm on consistent basis.
You seek and utilize opportunities for continuous learning and self-development.
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 are able to solve problems at root cause rather than at symptom level.
You can develop innovative solutions to problems.
You solve problems using logic and insight.
You are effective in solving problems.
Results Oriented	Needs Significant Development 1	2	Capable and Effective 3	4	Role Model 5
You work toward achievement of goals even when confronted with obstacles.
You help others when free-time is available.
You provide clear expectations for employees.
You stay focused on meeting the needs of customers.
You inspire and motivates co-workers to be productive and energetic at work
Safety	Needs Significant Development 1	2	Capable and Effective 3	4	Role Model 5
You point out behaviors in others that may be unsafe.
You support our company's safety programs.
You keep accurate safety records.
You support safety programs and procedures.
You ensure compliance with safety regulations.
Customer Focus	Needs Significant Development 1	2	Capable and Effective 3	4	Role Model 5
You develop good rapport and trust with the customer.
You consistently model positive customer service attitudes.
You consider customers point of view when making decisions.
You develop strong customer relationships.
You ensure all customer commitments and requirements are met or exceeded.
Partnering/Networking	Needs Significant Development 1	2	Capable and Effective 3	4	Role Model 5
You seek an understanding of diverse functions within the Company.
You maintain infrastructure to support partnerships and networks.
You collaborate with others to accomplish goals and objectives.
You forge mutually beneficial relationships between individuals with diverse backgrounds.
You partner with peers to obtain influence within the Company.
Conflict Management	Needs Significant Development 1	2	Capable and Effective 3	4	Role Model 5
You identify and takes steps to prevent potential confrontations.
You deal effectively with employee grievances.
You help employees to think through alternative ways to resolve conflict situations.
You discuss conflict situations with supervisor.
You try to understand others' point of view before making judgments

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: