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)
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:
Quality, Integrity, Continual Learning, Leadership, Persuasion and Influence, Technical, Interpersonal Skills, Developing Others, Others, Entrepreneurship, Global Perspective
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


Initiative

Needs
Improvement
Meets
Minimum
Standards
Is
Proficient
Role
Model
  1. Gladly seeks additional responsibilities.
  1. Anticipates problems and initiates plans to address them.
  1. Takes the initiative to solve pressing issues.
  1. Takes the initiative to complete tasks ahead of schedule.
  1. Takes on additional tasks without being asked or told to do so.
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. Organizes tasks for the most efficient order of completion.
  1. Switches attention to more urgent tasks when necessary.
  1. Assigns tasks based on skills of team members.
  1. Is aware of the deadlines for specific tasks/assignments.
  1. Begins tasks as soon as possible.
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. Works effectively in dynamic and changing work environments.
  1. Able to adjust to changes as needed.
  1. Accommodates changes as needed.
  1. Adjusts plans as needed based on changing conditions.
  1. Is flexible and open minded in dealing with others.
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. Consciously controls own negative emotions in order to keep team morale up.
  1. Deals with conflict by controlling own emotions by listening, being flexible, and sincere in responding.
  1. Uses patience and self-control in working with customers and associates.
  1. Sets an example for associates during stressful periods by maintaining a positive, can-do attitude.
  1. Analyzes interpersonal problems instead of reacting to them.
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. Highly effective supervisor.
  1. Provides resources to enable individuals to develop professionally.
  1. Takes ownership and accountability for results
  1. Motivates others to reach and exceed organizational goals and objectives.
  1. Demonstrates leadership and courage in critical situations.
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. Increased production by 20 percent.
  1. Demonstrates a sense of urgency to quickly and accurately solve problems and issues.
  1. Takes immediate action of projects that fall behind schedule.
  1. Demonstrates improvement in performance.
  1. Completes work promptly and efficiently.
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. Demonstrates the analytical skills to do their job.
  1. Takes a lot of pride in their work.
  1. Produces high quality work.
  1. Can be counted on to add value wherever they are involved.
  1. Demonstrates the functional or technical skills necessary to do their job.
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. Demonstrates congruence between statements and actions.
  1. Is trustworthy; is someone I can trust.
  1. Works in a way that makes others want to work with her/him.
  1. Communicates an understanding of the other person's interests, needs and concerns.
  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. Develops the skills and capabilities of others.
  1. Addresses employee behavior problems effectively.
  1. Meets regularly with employees to coach them on areas that will enhance their performance
  1. Coaches employees in how to strengthen knowledge and skills to improve work performance.
  1. Provides clear, motivating, and constructive feedback.
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. Takes the initiative to complete tasks.
  1. Understands the processes and various stages of business development.
  1. Excellent at managing relationships with stakeholders.
  1. Maintains a high level of energy to respond to demands of the job.
  1. Seeks and utilizes mentors to help guide professional development.
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. Provides budgeting and accounting support to the Company.
  1. Monitors expenses and verifies the need for items purchased.
  1. Effective in using Company's resources.
  1. Ensures others follow the correct rules and regulations on fiscal matters.
  1. Develops of the department's annual budget.
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.