Feedback - 360 Degree Feedback Survey Sample #6

360-Degree Assessment Survey

Dear Employee:

You have been selected to provide feedback on the employee listed above. Your feedback is an important part of our company's leadership development process and this survey is intended to gather broad feedback in the core competencies and role responsibilities that are important for the on-going success of our organization.

In responding to the questions below, think about your experiences working with this employee over the last twelve months. The effectiveness of this development tool is dependent on your honest, forthright and constructive responses so please bear this in mind as you answer each question. Your responses will be aggregated with the responses received from others and discussed with the employee to foster growth and on-going development.

We encourage everyone to complete the survey. Please be honest, constructive and thoughtful in your input. The survey is designed to help us understand more about your thoughts and needs to make this a great company.

The results of this survey will be used to help drive our future success. We will report back to you about what you have said and what we plan to do about it. 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

Feedback	Needs Significant Improvement	Could benefit from Development	Capable and Effective	Role Model
Looks to others for input.
Open to the suggestions of others.
Is easy to approach with ideas and opinions.
Accepts the views of others.
Asks others for their ideas and opinions.
Attitude	Needs Significant Improvement	Could benefit from Development	Capable and Effective	Role Model
Shows by their actions that they trust in the positive intentions of others.
Contributes to a positive and fun work environment.
Visibly supports and encourages diversity in style and background.
Treats all people fairly and with respect.
Is gracious and professional in their interactions with others.
Quality	Needs Significant Improvement	Could benefit from Development	Capable and Effective	Role Model
Encourages others to produce the highest quality work products.
Holds employees accountable for their quality of work.
Encourages others to achieve high quality standards.
Reflects on what is working and what could be improved.
Always strives to produce the highest quality work products.
Achievement	Needs Significant Improvement	Could benefit from Development	Capable and Effective	Role Model
Follows-up and takes action when goals are not met to ensure better results in the future.
Is determined to complete tasks regardless of obstacles that may occur.
Sets challenging goals for the department.
Created impactful reports for the re-organization committee.
Schedules time for self and others to optimize high priority and long term actions. Monitors progress towards business goals.
Safety	Needs Significant Improvement	Could benefit from Development	Capable and Effective	Role Model
Develops safety guidelines for the department.
Commits adequate resources toward safety measures.
Identifies and addresses safety needs.
Is not afraid to question a potential safety issue observed in the workplace.
Develops a sustainable safety culture.
Conflict Management	Needs Significant Improvement	Could benefit from Development	Capable and Effective	Role Model
Helps employees to think through alternative ways to resolve conflict situations.
Discusses conflict situations with supervisor.
Identifies and takes steps to prevent potential confrontations.
Clearly expresses expectations to others.
Tries to understand others' point of view before making judgments
Strategic Focus	Needs Significant Improvement	Could benefit from Development	Capable and Effective	Role Model
Reinforces the strategic messaging in various teams, meetings, seminars and workshops.
Communicates the company's strategic goals and decisions to teams and departments.
Identifies and addresses strategic risks impacting operations.
Develops strategies that are practical and can be feasibly implemented within a reasonable period of time.
Maintains a strategic focus to sustain competitiveness in changing business environments.
Entrepreneurship	Needs Significant Improvement	Could benefit from Development	Capable and Effective	Role Model
Is comfortable operating in an environment of uncertainty.
Understands the processes and various stages of business development.
Takes the initiative to complete tasks.
Exhibits determination and passion in completion of goals.
Maintains a high level of energy to respond to demands of the job.

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

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

    
    
42. Describe the greatest strengths of this person with regard to his/her overall effectiveness in performing his/her current responsibilities.
    
    
    
43. Describe the most important things this person could improve upon in order to increase his/her overall effectiveness in performing his/her current responsibilities.
    
    
    
44. Additional comments, if any for [Participant Name Here]'s assessment.