Feedback - 360 Degree Feedback Survey Sample #12

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

• Is easy to approach with ideas and opinions.
• Seeks feedback to enhance performance.
• Considers other's opinion and suggestions.
• Looks to others for input.
• Accepts the views of others.

Needs Improvement		Fully Proficient		Excels/ Role Model
Click this box to make your rating

Comments:

Passion To Learn

• Takes advantage of training opportunities when they arise.
• Is open to feedback from others.
• Inspires others to learn new things.
• Takes initiative for own learning and development.
• Is open minded and curious about learning new skills.

Needs Improvement		Fully Proficient		Excels/ Role Model
Click this box to make your rating

Comments:

Adaptability

• Is aware of changes to team personnel.
• Able to adapt to changes in technology and processes.
• Adapts quickly to new situations.
• Adjusts tactics and strategies.
• Is flexible when dealing with changes.

Needs Improvement		Fully Proficient		Excels/ Role Model
Click this box to make your rating

Comments:

Change Management

• Addresses organizational and departmental resistance to changes.
• Adopts changes to set and example for others to follow.
• Works cooperatively with others to implement changes.
• Develops plans for following through on the changes.
• Effective in implementing new organizational vision and values.

Needs Improvement		Fully Proficient		Excels/ Role Model
Click this box to make your rating

Comments:

Innovation

• Solves problems with insight and understanding.
• Creates improved methods or solutions for meeting goals and objectives.
• Challenges current procedures to develop other alternatives.
• Analyzes current procedures and identifies opportunities for improvement.
• Takes risks to advance important ideas.

Needs Improvement		Fully Proficient		Excels/ Role Model
Click this box to make your rating

Comments:

Strengths


Areas for Development


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