Initiative - 360 Degree Feedback Survey Sample #12

360 Feedback Survey

Instructions

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 comment section for that competency. Your responses will be compiled with feedback from others and presented to the recipient to help guide their ongoing development.

Partially completed forms can be saved by using the Save/Still Working button at the bottom of the page. You may return at a later time to complete/edit the form. Your saved responses will be shown each time you re-visit the feedback form. When you are certain that you have completed your responses and will be not making any changes, click the Complete button.

To what extent does [Participant Name] exhibit the following ...

SELECT the rating that best reflects the employee's performance in the areas listed.

Initiative

• Takes the initiative to complete tasks ahead of schedule.
• Immediately informs the supervisor of any critical incidents.
• Completes tasks without having to be told to do so.
• Does the right thing without being told.
• Initiates draft documents for the director.

Needs Improvement		Fully Proficient		Excels/ Role Model
Click this box to make your rating

Comments:

Integrity

• Does what was promised.
• Fosters an environment built upon trust.
• Protects the integrity and confidentiality of information
• Establishes relationships of trust, honesty, fairness, and integrity.
• Accepts responsibility for mistakes.

Needs Improvement		Fully Proficient		Excels/ Role Model
Click this box to make your rating

Comments:

Professional Development

• Allows employees to fully participate in employee training and professional development.
• Seeks opportunities for professional development.
• Demonstrate enthusiasm and a willingness to learn new skills and knowledge
• Seeks opportunities for continuous learning.
• Keep themselves up-to-date of technical/professional issues

Needs Improvement		Fully Proficient		Excels/ Role Model
Click this box to make your rating

Comments:

Cultural Awareness

• Respects the views offered by individuals with different cultural backgrounds.
• Aware of their own cultural views.
• Open to learning about different cultures.
• Respects others regardless of age, race, gender, nationality, or disability.
• May advocate for others with different cultural backgrounds.

Needs Improvement		Fully Proficient		Excels/ Role Model
Click this box to make your rating

Comments:

Planning

• Is able to clearly articulate the plan for the department/district.
• Accurately estimates the amount of materials/supplies needed for the project.
• Anticipates obstacles and ways to overcome them.
• Encourages others to follow the plan.
• Able to stay organized and focused using excellent planning skills.

Needs Improvement		Fully Proficient		Excels/ Role Model
Click this box to make your rating

Comments:

Strengths


Areas for Development


Please give any final comments or suggestions for [Participant Name Here]'s assessment.