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 seek feedback to enhance performance.
You consider other's opinion and suggestions.
You share past experiences with others as learning opportunities.
You are easy to approach with ideas and opinions.
You accept the views of others.
Performance	Needs Significant Development 1	2	Capable and Effective 3	4	Role Model 5
You produce quality
You have great overall performance
You shown significant improvement in job performance.
You work well in this position.
You are able to organize work.
Flexibility	Needs Significant Development 1	2	Capable and Effective 3	4	Role Model 5
I allow for flexibility in setting realistic performance goals.
You recognize and quickly adapt to shifts in the environment, market, or industry.
You adapt to circumstances as needed.
You implement changes as a result of having listened to employees
I continuously learn and adapt new techniques to address evolving challenges.
Adaptability	Needs Significant Development 1	2	Capable and Effective 3	4	Role Model 5
You perform a wide range of tasks, respond to changes in direction and priorities and accept new challenges, responsibilities, and assignments.
You are willing to change ideas or perceptions based on new information or contrary evidence which is presented.
You can adjust plans and procedures.
You adjust strategy when new information is presented.
You are proactive and takes steps to prepare for changes in the workplace.
Bias for Action	Needs Significant Development 1	2	Capable and Effective 3	4	Role Model 5
You complete work on time
You project a "can-do" attitude when interfacing with peers, subordinates and customers(especially during difficult and challenging times).
You complete a large volume of work.
You coach others to foster an environment which can adapt quickly and willingly to rapid change.
You convey a sense of urgency about addressing problems and opportunities
Problem Solving	Needs Significant Development 1	2	Capable and Effective 3	4	Role Model 5
You implement effective solutions to critical problems.
You identify fresh approaches and shows a willingness to question traditional assumptions.
You make judgments based upon relevant information.
You are able to solve problems at root cause rather than at symptom level.
You work cooperatively with others to solve problems.
Results Oriented	Needs Significant Development 1	2	Capable and Effective 3	4	Role Model 5
I overcome obstacles to continue working toward goals.
You help others when free-time is available.
You demonstrate the personal confidence to "stay the course," even when faced with difficulty
I determine the proper order for completion of the tasks.
I set benchmarks and milestones to measure progress toward the objectives.
Safety	Needs Significant Development 1	2	Capable and Effective 3	4	Role Model 5
You are not afraid to question a potential safety issue observed in the workplace.
You develop a strong safety culture.
You support our company's safety programs.
You develop a culture of safety.
You participate in safety training as applicable.
Customer Focus	Needs Significant Development 1	2	Capable and Effective 3	4	Role Model 5
You ask questions and listen carefully to determine customer needs and to ensure that the customer's needs are met.
You view customer satisfaction as an everyday priority.
You use feedback from the customer to help improve the customer's experience.
I make sure team members understand the issues faced by the customer.
I ensure that commitments made to customers are completed to the customer's satisfaction.
Partnering/Networking	Needs Significant Development 1	2	Capable and Effective 3	4	Role Model 5
You maintain a strong track record of networking and partnering.
I encourage colleagues to participate in networking opportunities.
I work to combine the unique strengths of each partner to develop new products or services.
You seek to reduce institutional roadblocks to information sharing.
I create strategic partnerships when resources are limited.
Conflict Management	Needs Significant Development 1	2	Capable and Effective 3	4	Role Model 5
I identify who holds the authority to make decisions.
I investigate opportunities to achieve mutually beneficial solutions to conflicts.
I avoid conflicts over minor issues.
You prepare team members to accept differing view points.
I seek to achieve mutually acceptable outcomes.

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: