Integrity - 360 Degree Feedback Survey Sample #5

360-Degree Assessment Survey

Dear Employee:

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 Closing Comments section. 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.

Please ensure that your submission is made by .

Thank you for your participation in the survey.

Management Team

Integrity	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Follows tasks to completion.
Maintains strong relationships with others.
Establishes relationships of trust, honesty, fairness, and integrity.
Demonstrates sincerity in actions with others.
Accepts responsibility for mistakes.
Passion To Learn	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Holds self and associates accountable for goal achievement.
Enjoys learning new skills and techniques.
Creates an environment that supports personal development and exploration.
Exhibits willingness to upgrade skills through additional training and education.
Takes initiative for own learning and development.
Creativity	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Is creative.
Develops solutions to challenging problems.
Adds value to the department/organization.
Creates a lot of new ideas.
Conceives, implements and evaluates ideas.
Feedback	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Considers other's opinion and suggestions.
Seeks feedback to enhance performance.
Looks to others for input.
Open to the suggestions of others.
Is easy to approach with ideas and opinions.
Establishing Focus/Direction	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Sets appropriate goals for employees.
Maintains focus when handling several problems or tasks simultaneously.
Makes sure that employees understand how their work relates to organizational goals.
Makes sure that employees understand and identify with the team's mission.
Aligns the department's goals with the goals of the organization.
Objectives	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Works toward achieving established goals and objectives.
Organizes and schedules events, activities, and resources.
Effectively organizes resources and plans
Ability to establish realistic goals.
Communicates goals and objectives to employees.
Co-worker Development	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Adapts coaching and mentoring approach to meet the style or needs of individuals
Gives others development opportunities through project assignments and increased job responsibilities
Provides ongoing feedback to co-workers on their development progress
Sets and clearly communicates expectations, performance goals, and measurements to others
Works to identify root causes of performance problems
Negotiation	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Identifies verbal and nonverbal cues to help interpret actions and messages.
Researches the needs of the other party to identify strengths and weaknesses of positions.
Able to influence others to accept certain positions.
Establishes clear communications to avoid misunderstandings.
Able to say "no" when it is essential to maintaining quality and high standards.
Strategic Insight	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Develops a strategic vision for the future.
Creates a mission statement describing the purpose for the organization.
Works with others to develop insights into the resources and actions required to produce desired results.
Creates strategic plans to develop and promote organizational and area strengths, as well as to address weaknesses based on insight from surveys.
Ensures that the department's goals are strategically aligned with the company's goals.

46. Overall, please rate the effectiveness of [Participant Name Here].
    

    5- Very Effective 4- Effective 3- Neither 2- Ineffective 1- Very Ineffective

    
    
47. Strengths
    
    
    
48. Areas for Development
    
    
    
49. Please give any final comments or suggestions for [Participant Name Here]'s assessment.