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 identify new opportunities to achieve goals
You are able to adapt to new situations.
You encourage others to adopt new procedures.
You act decisively in frequently changing and uncertain environment.
You are effective in incorporating new ideas.
Self Management	Role Model	Capable and Effective	Somewhat Effective	Needs Development
You analyze own reactions on the spot to ensure that communication does not appear to be driven by anger.
You step away from a situation to process appropriate response.
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 analyze interpersonal problems instead of reacting to them.
Objectives	Role Model	Capable and Effective	Somewhat Effective	Needs Development
You effectively organize resources and plans
You set long-term and short-term goals.
You work toward achieving established goals and objectives.
You organize and schedules events, activities, and resources.
You consistently provide me with timely feedback for improving my performance.
Collaboration	Role Model	Capable and Effective	Somewhat Effective	Needs Development
You encourage collaboration of fellow employees to achieve results.
You define shared goals with the committee members.
You build consensus among partners.
You allow various stakeholders to contribute their expertise to the solution of a problem.
You encourage collaboration with other departments.
Trustworthy	Role Model	Capable and Effective	Somewhat Effective	Needs Development
You build and maintain the trust of others.
You demonstrate congruence between statements and actions.
You consistently keep commitments.
You seek to mitigate grievances by clarifying intentions and finding suitable remedies.
You are a person others can count on.
Strategic Focus	Role Model	Capable and Effective	Somewhat Effective	Needs Development
You are able to decline a poor strategy by proposing alternate strategies.
You communicate goals and objectives to employees.
You focus attention on treating the causes of problems rather than simply addressing the symptoms.
You sustain or achieves a competitive advantage for the organization by analyzing the best practices and lessons learned from other organizations.
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
You are open to input from others into the plan for the project.
You anticipate obstacles and ways to overcome them.
I develop strategic plans for the company/organization.
You assess the potential impact of changes to the strategic plan.
You anticipate potential challenges, develops plan to overcome them and then carries out the plan.

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.