Initiative - 360 Degree Feedback Survey Sample #5

360-Degree Assessment Survey

Dear Employee:

Thank you for providing feedback for the recipient above. As you respond, please draw on your first-hand experience with this individual in the past 12 months. Rate each item using the scale shown. If you don't feel you have enough first-hand information to rate a certain item, please choose the Not Applicable option. 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 the recipient to help guide their ongoing development.

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Thank you for your participation in the survey.

Management Team

Initiative	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Prepares for unexpected contingencies.
Analyzes the needs of the situation and acts before being told to do so.
Independently seeks out new learning opportunities to improve their skills.
Is proactive and gets things done.
Acts with urgency when time is of the essence.
Expands the offerings of the department by working evenings and weekends.
Change Management	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Addresses organizational and departmental resistance to changes.
Supports new initiatives for organizational changes to improve effectiveness.
Is an inspiration for others to accept the recent changes.
Inspires others to want to change.
Develops plans for following through on the changes.
Facilitates change with minimal resistance.
Developing Others	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Creates opportunities for professional development.
Develops employees by offering and encouraging them to take on new or additional responsibilities.
Is open to receiving feedback.
Tries to ensure employees are ready to move to the next level.
Creates a work environment that fosters positive feedback to employees.
Assesses employees' developmental needs.
Fiscal Management	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Develops budgets and plans for various programs and initiatives.
Effective in using Company's resources.
Monitors expenses and verifies the need for items purchased.
Develops of the department's annual budget.
Monitors spending.
Ensures others follow the correct rules and regulations on fiscal matters.
Vision	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Envisions and articulates a clear path for the department's accelerated growth over the next year.
Develops and executes a strategic vision for the organization.
Creates a vision to align employees around a long-term goal for the department.
Ensures that work is systematically aligned and coordinated with the organization's vision.
Encourages employees to prioritize activities that contribute to the vision.
Crafts strategic plans that embody the organization's shared vision.

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

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

    
    
32. Strengths
    
    
    
33. Areas for Development
    
    
    
34. Please give any final comments or suggestions for [Participant Name Here]'s assessment.