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 are able to adapt to new situations.
You adapt to new organizational structures, policies, or procedures.
You act decisively in frequently changing and uncertain environment.
You work effectively during periods of change.
You encourage others to adopt new procedures.
Self Management	Role Model	Capable and Effective	Somewhat Effective	Needs Development
You analyze interpersonal problems instead of reacting to them.
You consciously control own negative emotions in order to keep team morale up.
You set an example for associates during stressful periods by maintaining a positive, can-do attitude.
You deal with conflict by controlling own emotions by listening, being flexible, and sincere in responding.
You are aware of personal impact on others and adjusts behavior to create a positive leadership presence.
Objectives	Role Model	Capable and Effective	Somewhat Effective	Needs Development
You assure [Company] principles are understood, employed & pursued.
You consistently provide me with timely feedback for improving my performance.
You are able to establish realistic goals.
You organize and schedules events, activities, and resources.
You effectively organize resources and plans
Collaboration	Role Model	Capable and Effective	Somewhat Effective	Needs Development
You encourage collaboration with other departments.
You respect other group/team members.
You promote open participation and communication within department and throughout the organization.
You identify and organize partnerships and alliances.
You build consensus among team members.
Trustworthy	Role Model	Capable and Effective	Somewhat Effective	Needs Development
You consistently keep commitments.
You work in a way that makes others want to work with you.
You demonstrate congruence between statements and actions.
You take care to maintain confidential information.
You build and maintain the trust of others.
Strategic Focus	Role Model	Capable and Effective	Somewhat Effective	Needs Development
You scan the environment for opportunities to exploit.
I identify strengths that competitors would have trouble imitating.
You strategically deploy resources to areas of the greatest need.
You ensure the department has a viable strategy for moving forward.
You monitor performance of each market within the Area, utilizing reports to ensure sales growth, cost management, and profitability targets are met.
Planning	Role Model	Capable and Effective	Somewhat Effective	Needs Development
I prioritize plans based on a cost/benefit analysis.
I conduct regular assessments of the project status to ensure adherence to the set schedule.
I encourage others to follow the plan.
I reduce uncertainty in the department through clear planning and schedules.
I develop plans used to accomplish urgent or critical tasks.

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.