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Feedback - 360 Degree Feedback Survey Sample #5





360-Degree Assessment Survey

Questionnaires Measuring Feedback:
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)
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.

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.

Please ensure that your submission is made by .

Thank you for your participation in the survey.

Management Team



Feedback

Role
Model
Capable and
Effective
Somewhat
Effective
Needs
Development
  1. Seeks feedback to enhance performance.
  1. Is easy to approach with ideas and opinions.
  1. Shares past experiences with others as learning opportunities.
  1. Asks others for their ideas and opinions.
  1. Is visible and approachable.


Attitude

Role
Model
Capable and
Effective
Somewhat
Effective
Needs
Development
  1. Contributes to a positive work environment.
  1. Shows by their actions that they trust in the positive intentions of others.
  1. Works to eliminate unnecessary work or barriers that get in others' way.
  1. Is gracious and professional in their interactions with others.
  1. Visibly supports and encourages diversity in style and background.


Trustworthy

Role
Model
Capable and
Effective
Somewhat
Effective
Needs
Development
  1. Communicates an understanding of the other person's interests, needs and concerns.
  1. Delivers on promises made.
  1. Is a person you can trust.
  1. Demonstrates congruence between statements and actions.
  1. Demonstrates a sense of responsibility and commitment to public trust.


Customer Focus

Role
Model
Capable and
Effective
Somewhat
Effective
Needs
Development
  1. Develops good rapport and trust with the customer.
  1. Does not hesitate to address customer concerns or complaints.
  1. Considers customers point of view when making decisions.
  1. Maintains positive customer relationships.
  1. Consistently models positive customer service attitudes.


Strategic Insight

Role
Model
Capable and
Effective
Somewhat
Effective
Needs
Development
  1. Analyzes records and reports to obtain insight into potential issues and trends.
  1. Maintains knowledge of current trends in the industry.
  1. Implements long-term solutions to problems.
  1. Understands the Company's strengths and weaknesses and uses this information to create optimal solutions to problems.
  1. Formulates policies and strategies for addressing the Company's important challenges.


Vision

Role
Model
Capable and
Effective
Somewhat
Effective
Needs
Development
  1. Behaves in a way that is consistent with business values & code of conduct
  1. Creates a common vision for others.
  1. Leads employees in new directions.
  1. Expresses the Company vision in a way that is easily understood and adopted by employees.
  1. Communicates a vision of where the Company needs to be in the future.



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






  2. Strengths


  3. Areas for Development


  4. Please give any final comments or suggestions for [Participant Name Here]'s assessment.