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 do the right thing without being told.
I take corrective action to rectify issues.
You seek and utilize opportunities for continuous learning and self-development.
When working on a problem in a team, I often am the first to suggest possible solutions.
You act on own initiative to improve the department outcomes.
Commitment To Result	Needs Significant Improvement	Could benefit from Development	Capable and Effective	Role Model
You maintain persistence and dedication to achieving results.
You coordinate all department activities into a cohesive team effort.
You encourage commitment in others to obtain results.
You create a sense of urgency among the store team members to complete activities, which drive sales.
You take immediate action toward goals.
Conflict Management	Needs Significant Improvement	Could benefit from Development	Capable and Effective	Role Model
You discuss conflict situations with supervisor.
You identify and takes steps to prevent potential confrontations.
You assist team members by helping them see the other point of view.
You deal effectively with employee grievances.
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 do not allow own emotions to interfere with the performance of others.
You step away from a situation to process appropriate response.
You consciously control own negative emotions in order to keep team morale up.
You deal with conflict by controlling own emotions by listening, being flexible, and sincere in responding.
You analyze own reactions on the spot to ensure that communication does not appear to be driven by anger.
Establishing Focus/Direction	Needs Significant Improvement	Could benefit from Development	Capable and Effective	Role Model
You maintain self-control when personally criticized.
You function well under stress, deadlines, and/or significant workloads.
You stay focused even when under pressure and stress.
You set appropriate goals for employees.
You align the department's goals with the goals of the organization.
Quality	Needs Significant Improvement	Could benefit from Development	Capable and Effective	Role Model
You encourage others to produce the highest quality work products.
You correct issues in a timely manner.
You encourage employees to produce the best quality products.
You hold employees accountable for your quality of work.
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 generate alternative solutions to problems and challenges.
You identify and assess all potential responses to a problem.
You are effective in solving problems.
You implement effective solutions to critical problems.
You work cooperatively with others to solve problems.
Negotiation	Needs Significant Improvement	Could benefit from Development	Capable and Effective	Role Model
You identify verbal and nonverbal cues to help interpret actions and messages.
You are flexible in responses.
You influence others through rational argument and persuasion.
You establish good working relationships with others.
You stay calm and focus on the core issues to be discussed.
Recognition	Needs Significant Improvement	Could benefit from Development	Capable and Effective	Role Model
You recognize team members who offer a significant contribution to a project.
You reinforce and reward employees for accomplishing necessary goals.
You make people around them feel appreciated and valued.
You say "thank you" to show appreciation for work of others.
You let employees know when they have done well
Entrepreneurship	Needs Significant Improvement	Could benefit from Development	Capable and Effective	Role Model
You are excellent at managing relationships with stakeholders.
You devote a certain amount of time and effort to developing new business opportunities.
You are able to adapt the department to changing business demands and climate.
You encourage dynamic growth opportunities.
You find unique ways to go around barriers to success.

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.