Flexibility - 360 Degree Feedback Survey Sample #5

360-Degree Assessment Survey

Dear Employee:

Thank you for participating in a 360-degree feedback assessment. In this process, you will complete a self-assessment questionnaire (below). You will also receive feedback from others including your manager, peers and direct reports. As you respond, please respond using just your experiences in the past 12 months. Rate each item using the scale shown. 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 you at the conclusion of this assessment to help guide your ongoing professional 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

Flexibility	Role Model	Capable and Effective	Somewhat Effective	Needs Development
You can handle changes without complaining.
You act decisively in frequently changing and uncertain environment.
You are open to alternative ways to accomplish goals
You adapt to circumstances as needed.
You implement changes as a result of having listened to employees
Self Management	Role Model	Capable and Effective	Somewhat Effective	Needs Development
You do not allow own emotions to interfere with the performance of others.
You are aware of personal impact on others and adjusts behavior to create a positive leadership presence.
You use patience and self-control in working with customers and associates.
You analyze own reactions on the spot to ensure that communication does not appear to be driven by anger.
You consciously control own negative emotions in order to keep team morale up.
Objectives	Role Model	Capable and Effective	Somewhat Effective	Needs Development
You are able to establish realistic goals.
You encourage others to take on greater responsibility.
You are able to organize work.
You consistently provide me with timely feedback for improving my performance.
You communicate goals and objectives to employees.
Collaboration	Role Model	Capable and Effective	Somewhat Effective	Needs Development
You are comfortable working with employees from different departments/divisions.
You consult with other partners on issues.
You a trustworthy and credible partner.
You work cooperatively with others to solve problems.
You allow various stakeholders to contribute their expertise to the solution of a problem.
Trustworthy	Role Model	Capable and Effective	Somewhat Effective	Needs Development
You consistently keep commitments.
You deliver on promises made.
You communicate an understanding of the other person's interests, needs and concerns.
You take ownership, deliver on commitments
You demonstrate a sense of responsibility and commitment to public trust.
Strategic Focus	Role Model	Capable and Effective	Somewhat Effective	Needs Development
You are able to decline a poor strategy by proposing alternate strategies.
You monitor performance of each market within the Area, utilizing reports to ensure sales growth, cost management, and profitability targets are met.
You look for opportunities to enhance contributions to the bottom line.
You sustain or achieves a competitive advantage for the organization by analyzing the best practices and lessons learned from other organizations.
You understand your role within the organization.
Planning	Role Model	Capable and Effective	Somewhat Effective	Needs Development
You make plans and follows through.
You are able to identify the needs of the department before a major change.
You anticipate potential challenges, develops plan to overcome them and then carries out the plan.
You are able to look ahead (beyond the present) when addressing the work/needs of the department.
You work in an organized manner

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

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

    
    
37. Strengths
    
    
    
38. Areas for Development
    
    
    
39. Please give any final comments or suggestions for [Participant Name Here]'s assessment.