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

• Inspires others to perform above expectations.
• Confronts problems immediately without supervisor instructions.
• Expands the offerings of the department by working evenings and weekends.
• Initiates actions that impact the department/company.
• Seizes upon opportunities available.

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

Comments:

Integrity

• Develops trust and confidence from others.
• Accepts responsibility for mistakes.
• Demonstrates sincerity in actions with others.
• Protects the integrity and confidentiality of information
• Demonstrates honesty and truthfulness at all times.

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

Comments:

Professional Development

• Keep themselves up-to-date of technical/professional issues
• Allows employees to fully participate in employee training and professional development.
• Demonstrate enthusiasm and a willingness to learn new skills and knowledge
• Encourages employees to take courses relevant to their job.
• Quickly acquire and apply new knowledge and skills when needed

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

Comments:

Cultural Awareness

• Avoids referring to stereotypes about others from different cultures.
• Seeks to reduce obstacles in communication that might arise from cultural differences.
• Recognizes and values individual and cultural differences.
• Understands what customs and etiquette are important for individuals from other cultures.
• Engages with individuals that have different cultural backgrounds.

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

Comments:

Planning

• Creates effective project plans.
• Involves relevant coworkers in the development of the plan.
• Initiates the planning process by defining the scope of the project.
• Plans for future staffing needs.
• Analyzes market trends to plan the best course of action.

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.