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 action without being asked.
• Prepares for unexpected contingencies.
• Takes decisive action to address problems, following up with relevant team members and coaching them on how to improve.
• Immediately works to complete goals well before their deadline.
• Goes above and beyond the stated goals.

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

Comments:

Integrity

• Protects the integrity and confidentiality of information
• Demonstrates honesty and truthfulness at all times.
• Establishes relationships of trust, honesty, fairness, and integrity.
• Maintains strong relationships with others.
• Demonstrates sincerity in actions with others.

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
• Keep themselves up-to-date of technical/professional issues
• Encourages employees to take courses relevant to their job.
• Seeks opportunities for continuous learning.
• Seeks opportunities for professional development.

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.
• Shows respect in daily interactions
• Fosters a diverse workforce free from discrimination and harassment.
• Respects others regardless of age, race, gender, nationality, or disability.
• Treats others with dignity and respect.

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

Comments:

Planning

• Anticipates obstacles and ways to overcome them.
• Anticipates potential challenges, develops plan to overcome them and then carries out the plan.
• Able to identify the needs of the department before a major change.
• Delegates role to team members to accomplish goals.
• Works in an organized manner

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.