Initiative - 360 Degree Feedback Survey Sample #12

360 Feedback Survey

Instructions

We appreciate you taking the time to provide valuable feedback for the individual mentioned above. As you respond, please draw on your first-hand experience with this individual in the past 12 months. Your insights are crucial in offering a comprehensive evaluation. Please rate each item using the scale provided. If you find that you do not have sufficient first-hand knowledge to rate a particular item, select the Not Applicable option.

In addition to the ratings, we encourage you to include comments where possible. These comments are particularly useful when you give a very high or very low rating, as they provide context and clarity regarding your assessment. Explaining your reasons in the comment section helps ensure that your feedback is constructive and actionable.

Your responses, combined with feedback from other contributors, will be compiled and presented to the individual. This collective feedback aims to support their continuous growth and development by highlighting strengths and identifying areas for improvement. Your thoughtful participation is essential in helping them achieve their full potential.

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.

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Initiative

• Is an inspiration for others to perform above expectations.
• Initiates projects that have an impact on the department.
• Immediately works on solving problems.
• Completes tasks without having to be told to do so.
• Immediately works to complete goals well before their deadline.

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

Comments:

Integrity

• Fosters an environment built upon trust.
• Follows tasks to completion.
• Does what was promised.
• Demonstrates honesty and truthfulness at all times.
• Accepts responsibility for mistakes.

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

Comments:

Professional Development

• Encourages employees to take courses relevant to their job.
• Seeks opportunities for professional development.
• Demonstrate enthusiasm and a willingness to learn new skills and knowledge
• Seeks opportunities for continuous learning.
• Contributing fully to the extent of their skills

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

Comments:

Cultural Awareness

• Recognizes and values individual and cultural differences.
• Shows respect in daily interactions
• Seeks opportunities to learn about the other cultural backgrounds of colleagues.
• Avoids referring to stereotypes about others from different cultures.
• Participates in cultural training sessions/classes.

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

Comments:

Planning

• Ensures everyone in the department is onboard with the current plan.
• Develops plans used to accomplish urgent or critical tasks.
• Develops good plans used for logistics.
• Open to input from others into the plan for development of the strategic plan.
• Ensures staff have the supplies and resources necessary to enact the plan.

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.