Initiative - 360 Degree Feedback Survey Sample #6

360-Degree Assessment Survey

Dear Employee:

You have been selected to participate in a 360-assessment. As part of this process you will need to complete the self-assessment questionnaire below.

In responding to the questions below, think about your experiences over the last 12 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. A report will be shared with you at the conclusion of this project.

We encourage everyone to complete the survey. Please be honest, constructive and thoughtful in your input. The survey is designed to help us understand more about your thoughts and needs to make this a great company.

The results of this survey will be used to help drive our future success. We will report back to you about what you have said and what we plan to do about it. If you have any questions about the process please contact [Contact Person].

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 Significant Improvement	Could benefit from Development	Capable and Effective	Role Model
I look for opportunities to move projects forward.
You are a self-starter. You do not wait to be told to do something.
You take the initiative to complete tasks ahead of schedule.
I look to start work on new projects without waiting for direction from the manager.
I build strong interpersonal relationships upon first meeting.
Commitment To Result	Needs Significant Improvement	Could benefit from Development	Capable and Effective	Role Model
You are willing to do whatever it takes-not afraid to have to put in extra effort.
You create a sense of urgency among the store team members to complete activities, which drive sales.
You maintain persistence and dedication to achieving results.
You encourage commitment in others to obtain results.
You coordinate all department activities into a cohesive team effort.
Conflict Management	Needs Significant Improvement	Could benefit from Development	Capable and Effective	Role Model
I avoid conflicts over minor issues.
I ensure that both parties work toward finding compromise.
I remove misperceptions that may be contributing to the conflict.
I work to reduce misunderstandings and poor communication.
You establish roles and responsibilities.
Self Management	Needs Significant Improvement	Could benefit from Development	Capable and Effective	Role Model
You use patience and self-control in working with customers and associates.
You deal with conflict by controlling own emotions by listening, being flexible, and sincere in responding.
You consciously control own negative emotions in order to keep team morale up.
You are aware of personal impact on others and adjusts behavior to create a positive leadership presence.
You analyze interpersonal problems instead of reacting to them.
Establishing Focus/Direction	Needs Significant Improvement	Could benefit from Development	Capable and Effective	Role Model
You align the department's goals with the goals of the organization.
You maintain self-control when personally criticized.
You help guide employees with prioritizing tasks.
You function well under stress, deadlines, and/or significant workloads.
You are excellent at managing time.
Quality	Needs Significant Improvement	Could benefit from Development	Capable and Effective	Role Model
You analyze quality improvement plans and initiatives.
You develop specific quality standards/goals to be met within a specified timeframe.
I am able to identify quality issues critical to the organization.
You ensure high consistency across batches or production runs.
You analyze what occurred and re-adjusts accordingly when goals are not met.
Problem Solving	Needs Significant Improvement	Could benefit from Development	Capable and Effective	Role Model
You implement effective solutions to critical problems.
You understand the root causes of problems.
You make judgments based upon relevant information.
You find creative ways to get things done with limited resources.
You can develop innovative solutions to problems.
Negotiation	Needs Significant Improvement	Could benefit from Development	Capable and Effective	Role Model
You establish clear communications to avoid misunderstandings.
You keep the negotiations constructive and focused on problem-solving rather than conflict.
I am aware of wht problems need to be solved.
You create a decisive, team-oriented environment; clarifies goals; and outlines a strategic agenda.
You are resolute when stating priorities and non-negotiables.
Recognition	Needs Significant Improvement	Could benefit from Development	Capable and Effective	Role Model
You say "thank you" to show appreciation for work of others.
You recognize team members who offer a significant contribution to a project.
You find opportunities to recognize others.
You make people around them feel appreciated and valued.
You readily share credit and gives others opportunity for visibility.
Entrepreneurship	Needs Significant Improvement	Could benefit from Development	Capable and Effective	Role Model
You are comfortable operating in an environment of uncertainty.
You understand the processes and various stages of business development.
You exhibit determination and passion in completion of goals.
You take the initiative to complete tasks.
You can work effectively in an environment of uncertainty.

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

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

    
    
52. Describe the greatest strengths of this person with regard to his/her overall effectiveness in performing his/her current responsibilities.
    
    
    
53. Describe the most important things this person could improve upon in order to increase his/her overall effectiveness in performing his/her current responsibilities.
    
    
    
54. Additional comments, if any for [Participant Name Here]'s assessment.