Feedback - 360 Degree Feedback Survey Sample #11

360 Feedback Survey

Instructions

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 comment section for that competency. 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.

To what extent does [Participant Name] exhibit the following ...

SELECT the rating that best reflects the employee's performance in the areas listed.

Feedback

What does Feedback mean?
It means that ...

• You look to others for input.
• You are visible and approachable.
• You actively seek feedback from others.
• You seek feedback to enhance performance.
• You share past experiences with others as learning opportunities.

To what extent does this person exhibit Feedback?
Select from one of the ratings below.

Not Applicable or Unable to Judge

Poor does not perform to expected standards; often unable to complete tasks; does not seek help or advice

Minimal completes tasks only when pressured to do so; is satisfied with minimal progress; only does what is required

Average completes tasks easily; seeks to obtain maximal performance; willing to seek advice and help when needed

Role Model is a role model for others to follow; goes above and beyond what is expected; helps others

Project Management

What does Project Management mean?
It means that ...

• You prepare contingency plans to avoid supply chain disruptions.
• You establish the scope for the project.
• You present clear and accurate status information to required constituents.
• You work with both internal and external individuals to facilitate the project.
• You create the communications that will be used throughout the project's implementation.

To what extent does this person exhibit Project Management?
Select from one of the ratings below.

Not Applicable or Unable to Judge

Poor does not perform to expected standards; often unable to complete tasks; does not seek help or advice

Minimal completes tasks only when pressured to do so; is satisfied with minimal progress; only does what is required

Average completes tasks easily; seeks to obtain maximal performance; willing to seek advice and help when needed

Role Model is a role model for others to follow; goes above and beyond what is expected; helps others

Decision Making

What does Decision Making mean?
It means that ...

• I decide which short- and long-term goals should be created.
• You are willing to consider information from other sources.
• You weigh the pros and cons of decisions.
• I am open to listening to others who may have different ideas.
• You are firm in your decision and not easily influenced by the whims of others.

To what extent does this person exhibit Decision Making?
Select from one of the ratings below.

Not Applicable or Unable to Judge

Poor does not perform to expected standards; often unable to complete tasks; does not seek help or advice

Minimal completes tasks only when pressured to do so; is satisfied with minimal progress; only does what is required

Average completes tasks easily; seeks to obtain maximal performance; willing to seek advice and help when needed

Role Model is a role model for others to follow; goes above and beyond what is expected; helps others

Safety

What does Safety mean?
It means that ...

• You are aware of osha safety guidelines.
• You participate in safety training when available.
• You ensure compliance with safety regulations.
• You develop a sustainable safety culture.
• You commit adequate resources toward safety measures.

To what extent does this person exhibit Safety?
Select from one of the ratings below.

Not Applicable or Unable to Judge

Poor does not perform to expected standards; often unable to complete tasks; does not seek help or advice

Minimal completes tasks only when pressured to do so; is satisfied with minimal progress; only does what is required

Average completes tasks easily; seeks to obtain maximal performance; willing to seek advice and help when needed

Role Model is a role model for others to follow; goes above and beyond what is expected; helps others

Co-worker Development

What does Co-worker Development mean?
It means that ...

• You work to identify root causes of performance problems
• You set and clearly communicate expectations, performance goals, and measurements to others
• You give others development opportunities through project assignments and increased job responsibilities
• You provide ongoing feedback to co-workers on your development progress
• You adapt coaching and mentoring approach to meet the style or needs of individuals

To what extent does this person exhibit Co-worker Development?
Select from one of the ratings below.

Not Applicable or Unable to Judge

Poor does not perform to expected standards; often unable to complete tasks; does not seek help or advice

Minimal completes tasks only when pressured to do so; is satisfied with minimal progress; only does what is required

Average completes tasks easily; seeks to obtain maximal performance; willing to seek advice and help when needed

Role Model is a role model for others to follow; goes above and beyond what is expected; helps others

Strengths


Areas for Development


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