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Initiative - 360 Degree Feedback Survey Sample #1





360-Degree Feedback Survey

Questionnaires Measuring Initiative:
Survey 1 (4-point scale; Competency Comments)
Survey 2 (4-point scale; Competency Comments)
Survey 3 (5-point scale; Competency Comments)
Survey 4 (5-point scale; radio buttons)
Survey 5 (4-point scale; words)
Survey 6 (4-point scale; words)
Survey 7 (5-point scale; competency comments; N/A)
Survey 8 (3-point scale; Agree/Disagree words; N/A)
Survey 9 (3-point scale; Strength/Development; N/A)
Survey 10 (Comment boxes only)
Survey 11 (Single rating per competency)
Survey 12 (Slide-bar scale)
Survey 13 (4-point scale; numbers; floating anchors)
Survey 14 (4-point scale; N/A)
Instructions:

[Company] is conducting a 360-Degree Feedback Assessment developed by HR-Survey for selected managers.

You have been selected to provide feedback on the employee listed above. Your feedback is an important part of our company's leadership development process and this survey is intended to gather broad feedback in the core competencies and role responsibilities that are important for the on-going success of our organization.

In responding to the questions below, think about your experiences working with this employee over the last twelve months. The effectiveness of this development tool is dependent on your honest, forthright and constructive responses so please bear this in mind as you answer each question. Your responses will be aggregated with the responses received from others and discussed with the employee to foster growth and on-going 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.

Competencies Included:
Initiative, Juggling Multiple Responsibilities, Adaptability, Self Management, Leadership, Achievement, Excellence, Trustworthy, Coaching, Entrepreneurship, Fiscal Management
Sample Result Document:
Sample Results
Your feedback is valuable in helping the individual to understand how they are perceived and experienced by others and the impact their behavior has on people in the organization with whom they interact. Feedback received also acknowledges strengths and identifies areas for development.

Use the form below to provide your feedback. Each field and comment box requires a response before you can SUBMIT your final feedback.

Please ensure that your submission is made between . The survey will only be available during these dates.

Thank you for your participation in the survey. We look forward to seeing the analysis of your responses and we are hoping for 100% participation.

Management Team
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Initiative

Needs
Improvement
Meets
Minimum
Standards
Is
Proficient
Role
Model
  1. Informs the manager of any important changes in the equipment operation.
  1. Takes the initiative to change the direction or course of events.
  1. Actively works on resolving the issue instead of procrastinating or hoping it will resolve itself.
  1. Seizes upon chances to improve the department's prospects.
  1. Acts with urgency when time is limited.
  1. Seizes upon opportunities available.
  1. Takes corrective action to address performance deficiencies/issues.
  1. Begins immediate action on projects.
  1. Takes on extra projects after required work is completed.
If [Participant Name] were to make improvements in Initiative, what are your suggestions for how he/she can improve this?

Juggling Multiple Responsibilities

Needs
Improvement
Meets
Minimum
Standards
Is
Proficient
Role
Model
  1. Begins tasks as soon as possible.
  1. Observes, analyzes, and responds to merchandise needs while serving customers and accomplishing operational tasks.
  1. Can multitask while performing all of their other responsibilities and activities.
  1. Spends the most time and effort on critical tasks first.
  1. Determines which tasks are critical and which tasks are optional.
If [Participant Name] were to make improvements in Juggling Multiple Responsibilities, what are your suggestions for how he/she can improve this?

Adaptability

Needs
Improvement
Meets
Minimum
Standards
Is
Proficient
Role
Model
  1. Adjusts priorities to the new Corporate mission.
  1. Adjusts tactics and strategies.
  1. Able to respond to incidents without stopping the workflow.
  1. Able to work effectively with new people and new teams.
  1. Learns from personal experiences and/or mistakes.
If [Participant Name] were to make improvements in Adaptability, what are your suggestions for how he/she can improve this?

Self Management

Needs
Improvement
Meets
Minimum
Standards
Is
Proficient
Role
Model
  1. Steps away from a situation to process appropriate response.
  1. Analyzes interpersonal problems instead of reacting to them.
  1. Consciously controls own negative emotions in order to keep team morale up.
  1. Is aware of personal impact on others and adjusts behavior to create a positive leadership presence.
  1. Sets an example for associates during stressful periods by maintaining a positive, can-do attitude.
If [Participant Name] were to make improvements in Self Management, what are your suggestions for how he/she can improve this?

Leadership

Needs
Improvement
Meets
Minimum
Standards
Is
Proficient
Role
Model
  1. Provides resources to enable individuals to develop professionally.
  1. Acts decisively in implementing decisions.
  1. Effectively leads others.
  1. Sets clear goals and objectives for subordinates.
  1. Motivates others to reach and exceed organizational goals and objectives.
If [Participant Name] were to make improvements in Leadership, what are your suggestions for how he/she can improve this?

Achievement

Needs
Improvement
Meets
Minimum
Standards
Is
Proficient
Role
Model
  1. Takes calculated risks to achieve difficult goals.
  1. Works at a quick pace to complete a high volume of work.
  1. Sets ambitious standards of performance.
  1. Improved the quality of work on the production line.
  1. Schedules time for self and others to optimize high priority and long term actions. Monitors progress towards business goals.
If [Participant Name] were to make improvements in Achievement, what are your suggestions for how he/she can improve this?

Excellence

Needs
Improvement
Meets
Minimum
Standards
Is
Proficient
Role
Model
  1. Can be counted on to add value wherever they are involved.
  1. Takes a lot of pride in their work.
  1. Demonstrates the functional or technical skills necessary to do their job.
  1. Demonstrates the analytical skills to do their job.
  1. Produces high quality work.
If [Participant Name] were to make improvements in Excellence, what are your suggestions for how he/she can improve this?

Trustworthy

Needs
Improvement
Meets
Minimum
Standards
Is
Proficient
Role
Model
  1. Takes ownership, delivers on commitments
  1. Seeks to mitigate grievances by clarifying intentions and finding suitable remedies.
  1. Consistently keeps commitments.
  1. Is trustworthy; is someone I can trust.
  1. Builds and maintains the trust of others.
If [Participant Name] were to make improvements in Trustworthy, what are your suggestions for how he/she can improve this?

Coaching

Needs
Improvement
Meets
Minimum
Standards
Is
Proficient
Role
Model
  1. Meets regularly with employees to coach them on areas that will enhance their performance
  1. Develops the skills and capabilities of others.
  1. Conducts regular performance appraisals and feedback.
  1. Helps employees to understand responsibilities, authority, and expectations.
  1. Helps employees to maintain high personal standards.
If [Participant Name] were to make improvements in Coaching, what are your suggestions for how he/she can improve this?

Entrepreneurship

Needs
Improvement
Meets
Minimum
Standards
Is
Proficient
Role
Model
  1. Finds unique ways to go around barriers to success.
  1. Understands the processes and various stages of business development.
  1. Able to adapt the department to changing business demands and climate.
  1. Excellent at managing relationships with stakeholders.
  1. Exhibits determination and passion in completion of goals.
If [Participant Name] were to make improvements in Entrepreneurship, what are your suggestions for how he/she can improve this?

Fiscal Management

Needs
Improvement
Meets
Minimum
Standards
Is
Proficient
Role
Model
  1. Develops of the department's annual budget.
  1. Keeps excellent records for financial transparency.
  1. Monitors spending.
  1. Provides budgeting and accounting support to the Company.
  1. Effectively manages appropriations, reporting, purchases, expenditures, payrolls, and staff.
If [Participant Name] were to make improvements in Fiscal Management, what are your suggestions for how he/she can improve this?

  1. What are [Participant Name Here]'s greatest strengths demonstrated this year?


  2. What are [Participant Name Here]'s areas for development?


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