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
You seek and utilize opportunities for continuous learning and self-development.
You go above and beyond the stated goals.
You take decisive action to address problems, following up with relevant team members and coaching them on how to improve.
You take the initiative to change the direction or course of events.
You coach others to foster an environment which can adapt quickly and willingly to rapid change.
Commitment To Result	Needs Significant Improvement	Could benefit from Development	Capable and Effective	Role Model
You convey strong sense of own pride in Company to associates by creating a shared vision around sales and customer service.
You are able to focus on a task even when working alone.
You coordinate all department activities into a cohesive team effort.
You are willing to do whatever it takes-not afraid to have to put in extra effort.
You maintain persistence and dedication to achieving results.
Conflict Management	Needs Significant Improvement	Could benefit from Development	Capable and Effective	Role Model
You deal effectively with employee grievances.
You clearly express expectations to others.
You assist team members by helping them see the other point of view.
You identify and takes steps to prevent potential confrontations.
You help employees to think through alternative ways to resolve conflict situations.
Self Management	Needs Significant Improvement	Could benefit from Development	Capable and Effective	Role Model
You analyze own reactions on the spot to ensure that communication does not appear to be driven by anger.
You analyze interpersonal problems instead of reacting to them.
You do not allow own emotions to interfere with the performance of others.
You deal with conflict by controlling own emotions by listening, being flexible, and sincere in responding.
You are aware of personal impact on others and adjusts behavior to create a positive leadership presence.
Establishing Focus/Direction	Needs Significant Improvement	Could benefit from Development	Capable and Effective	Role Model
You maintain focus when handling several problems or tasks simultaneously.
You align the department's goals with the goals of the organization.
You are excellent at managing time.
You function well under stress, deadlines, and/or significant workloads.
You make sure that employees understand and identify with the team's mission.
Quality	Needs Significant Improvement	Could benefit from Development	Capable and Effective	Role Model
You encourage employees to produce the best quality products.
You encourage others to produce the highest quality work products.
You reflect on what is working and what could be improved.
You always strive to produce the highest quality work products.
You correct issues in a timely manner.
Problem Solving	Needs Significant Improvement	Could benefit from Development	Capable and Effective	Role Model
You are able to solve problems at root cause rather than at symptom level.
You solve problems using logic and insight.
You are a good problem solver and decision maker
You work cooperatively with others to solve problems.
You are effective in solving problems.
Negotiation	Needs Significant Improvement	Could benefit from Development	Capable and Effective	Role Model
You leverage relationships with others to achieve goals.
You are able to clearly express thoughts and concerns.
You conduct necessary preparations before engaging in negotiations.
You research the needs of the other party to identify strengths and weaknesses of positions.
You understand the expectations of other parties in the negotiation.
Recognition	Needs Significant Improvement	Could benefit from Development	Capable and Effective	Role Model
You recognize individuals for a specific outstanding achievement.
You recognize the abilities and skills of self and others
You offer recognition in a timely manner.
You let employees know when they have done well
You find opportunities to recognize others.
Entrepreneurship	Needs Significant Improvement	Could benefit from Development	Capable and Effective	Role Model
You encourage risk taking for developing potential business opportunities.
You are excellent at managing relationships with stakeholders.
You devote a certain amount of time and effort to developing new business opportunities.
You encourage dynamic growth opportunities.
You exhibit determination and passion in completion of goals.

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.