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

• Shares past experiences with others as learning opportunities.
• Considers other's opinion and suggestions.
• Is visible and approachable.
• Accepts the views of others.
• Open to the suggestions 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.
• Enjoys learning new skills and techniques.
• Holds self and associates accountable for goal achievement.
• Takes initiative for own learning and development.
• Stays up-to-date on emerging technologies.

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

Comments:

Adaptability

• Able to respond to incidents without stopping the workflow.
• Adapts to changes in team membership.
• Is open to change and adjusts plans when needed.
• Willing to change ideas or perceptions based on new information or contrary evidence which is presented.
• Continually trying to improve skills to remain current.

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

Comments:

Change Management

• Inspires others to accept changes.
• Addresses organizational and departmental resistance to changes.
• Assists others in understanding changes to the organization.
• Is a leading force driving changes.
• Facilitates change with minimal resistance.

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

Comments:

Innovation

• Encourages open communication to ensure that all proposals are considered.
• Searches for opportunities and innovative ways to improve the organization.
• Finds creative ways to get things done with limited resources.
• Builds upon the ideas and solutions of others.
• Implements best practices within the department.

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.