Feedback - 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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Please ensure that your submission is made by .

Thank you for your participation in the survey.

Management Team

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Feedback	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Is visible and approachable.
Shares past experiences with others as learning opportunities.
Is easy to approach with ideas and opinions.
Open to the suggestions of others.
Looks to others for input.
Attitude	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Contributes to a positive and fun work environment.
Treats all people fairly and with respect.
Contributes to a positive work environment.
Is gracious and professional in their interactions with others.
Shows by their actions that they trust in the positive intentions of others.
Trustworthy	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Takes ownership, delivers on commitments
Is a person you can trust.
Demonstrates congruence between statements and actions.
Seeks to mitigate grievances by clarifying intentions and finding suitable remedies.
Is trustworthy; is someone I can trust.
Customer Focus	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Is pro-active in dealing with customers and addressing their needs.
Consistently meets customer's needs.
Uses customer feedback to help improve products and services.
Is focused on improving customer services.
Develops good rapport and trust with the customer.
Strategic Insight	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Ensures that the department's goals are strategically aligned with the company's goals.
Creates strategic plans to develop and promote organizational and area strengths, as well as to address weaknesses based on insight from surveys.
Creates a vision for the organization based on insights gathered from other companies in the industry.
Maintains knowledge of current trends in the industry.
Develops a strategic vision for the future.
Vision	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Promotes a vision that inspires individuals to take risks to achieve greater rewards.
Aligns subordinates' work with the vision's critical priorities.
Develops a vision that is a catalyst for innovation and change.
Translates the department's vision into actionable objectives and a strategic plan.
Creates and executes a strategic vision that drives the company's growth forward.

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

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

    
    
32. Strengths
    
    
    
33. Areas for Development
    
    
    
34. Please give any final comments or suggestions for [Participant Name Here]'s assessment.