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 decisive action to address problems, following up with relevant team members and coaching them on how to improve.
• Addresses small problems before they become big ones.
• Looks for opportunities to move projects forward.
• Updates the documentation as soon as the situation changes.
• Anticipates problems and initiates plans to address them.

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

Comments:

Integrity

• Fosters a high standard of ethics and integrity.
• Establishes relationships of trust, honesty, fairness, and integrity.
• Demonstrates sincerity in actions with others.
• Does what was promised.
• Protects the integrity and confidentiality of information

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

Comments:

Professional Development

• Contributing fully to the extent of their skills
• Quickly acquire and apply new knowledge and skills when needed
• Seeks opportunities for professional development.
• Demonstrate enthusiasm and a willingness to learn new skills and knowledge
• 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

• Maintains an inclusive work environment that maximizes the talents of others in achieving goals.
• Understands the impact that our culture may have on interactions between individuals.
• Is aware of the similarities and differences among and between cultural groups.
• Actively listens to other employees' stories about their culture.
• Communicates with others without the influence of racism.

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

Comments:

Planning

• Creates to-do lists to make sure nothing is missed.
• Establishes and monitors timeframes and timelines.
• Determines what supplies/equipment will be needed for the department.
• Determines the allocation of funds based on plans for future development.
• Effectively uses logistics planning to reduce supply delays.

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.