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
Quickly comes to the aid of those who may need help.
Guides strategic initiatives to advance the department/organization.
Seizes upon chances to improve the department's prospects.
Takes action to establish clear and concise deadlines for tasks to be completed.
Confronts problems immediately without supervisor instructions.
Anticipates problems and initiates plans to address them.
Change Management	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Supports new initiatives for organizational changes to improve effectiveness.
Works cooperatively with others to implement changes.
Adopts changes to set and example for others to follow.
Supports the Company's efforts to implement changes.
Is a leading force driving changes.
Inspires others to accept changes.
Developing Others	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Develops employees by offering and encouraging them to take on new or additional responsibilities.
Sets performance objectives for subordinates that encourages development opportunities.
Supports the successes of other employees.
Encourages employees through recognition of positive changes in behavior.
Assigns tasks and responsibilities to develop skills of others.
Creates a work environment that fosters positive feedback to employees.
Fiscal Management	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Monitors expenses and verifies the need for items purchased.
Develops of the department's annual budget.
Ensures others follow the correct rules and regulations on fiscal matters.
Provides budgeting and accounting support to the Company.
Monitors spending.
Develops budgets and plans for various programs and initiatives.
Vision	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Creates a positive vision of the future for the Company.
Demonstrates consistency between words and actions
Understands the vision of the Company and promotes it ahead of any self-interests.
Behaves in a way that is consistent with business values & code of conduct
Communicates a vision of where the Company needs to be in the future.
Persuades others to follow the Company's 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.