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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Please ensure that your submission is made by .

Thank you for your participation in the survey.

Management Team

Initiative	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Goes above and beyond the stated goals.
Takes the initiative to change the direction or course of events.
Takes action without being asked.
Takes decisive action to address problems, following up with relevant team members and coaching them on how to improve.
Seeks and utilizes opportunities for continuous learning and self-development.
Prepares for unexpected contingencies.
Change Management	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Supports the Company's efforts to implement changes.
Works cooperatively with others to implement changes.
Adopts changes to set and example for others to follow.
Effective in implementing new organizational vision and values.
Addresses organizational and departmental resistance to changes.
Effective in dealing with ambiguous and challenging situations.
Developing Others	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Tries to ensure employees are ready to move to the next level.
Is open to receiving feedback.
Creates opportunities for professional development.
Supports the successes of other employees.
Creates a work environment that fosters positive feedback to employees.
Develops employees by offering and encouraging them to take on new or additional responsibilities.
Fiscal Management	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Develops budgets and plans for various programs and initiatives.
Provides budgeting and accounting support to the Company.
Effectively manages appropriations, reporting, purchases, expenditures, payrolls, and staff.
Keeps excellent records for financial transparency.
Develops of the department's annual budget.
Ensures others follow the correct rules and regulations on fiscal matters.
Vision	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Demonstrates consistency between words and actions
Develops action plans to align his/her work with the goals of the organization
Expresses the Company vision in a way that is easily understood and adopted by employees.
Communicates the vision and strategy of [Company]
Creates a positive vision of the future for the Company.
Leads employees in new directions.

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.