Integrity - 360 Degree Feedback Survey Sample #6

360-Degree Assessment Survey

Dear Employee:

You have been selected to participate in a 360-assessment. As part of this process you will need to complete the self-assessment questionnaire below.

In responding to the questions below, think about your experiences over the last 12 months. The effectiveness of this development tool is dependent on your honest, forthright and constructive responses so please bear this in mind as you answer each question. Your responses will be aggregated with the responses received from others. A report will be shared with you at the conclusion of this project.

We encourage everyone to complete the survey. Please be honest, constructive and thoughtful in your input. The survey is designed to help us understand more about your thoughts and needs to make this a great company.

The results of this survey will be used to help drive our future success. We will report back to you about what you have said and what we plan to do about it. If you have any questions about the process please contact [Contact Person].

Please ensure that your submission is made between . The survey will only be available during these dates.

Thank you for your participation in the survey. We look forward to seeing the analysis of your responses and we are hoping for 100% participation.

Management Team

Integrity	Needs Significant Improvement	Could benefit from Development	Capable and Effective	Role Model
You foster a high standard of ethics and integrity.
You demonstrate honesty and truthfulness at all times.
You demonstrate sincerity in actions with others.
You establish relationships of trust, honesty, fairness, and integrity.
You foster an environment built upon trust.
Professional Development	Needs Significant Improvement	Could benefit from Development	Capable and Effective	Role Model
You quickly acquire and apply new knowledge and skills when needed
You seek opportunities for continuous learning.
You allow employees to fully participate in employee training and professional development.
You are contributing fully to the extent of your skills
You encourage employees to take courses relevant to their job.
Persuasion and Influence	Needs Significant Improvement	Could benefit from Development	Capable and Effective	Role Model
You communicate effectively with others.
You attempt to persuade others rather than simply control them.
You seek to obtain consensus or compromise.
You are able to express own goals and needs.
You have excellent influencing/negotiating skills.
Innovation	Needs Significant Improvement	Could benefit from Development	Capable and Effective	Role Model
You build upon the ideas and solutions of others.
I ensure that employees feel safe to take risks and experiment without the fear of failure or retribution.
You foster a creative and innovative work environment.
You encourage others to experiment and learn from their mistakes without fear of retribution.
You take risks to reach beyond boundaries.
Achievement	Needs Significant Improvement	Could benefit from Development	Capable and Effective	Role Model
You accept setbacks and challenges as improvement opportunities
You eliminate bureaucratic barriers to streamline processes.
You set high standards in your performance
Your work improves the quality of work on the production line.
I work to meet required benchmarks for the position.
Technical	Needs Significant Improvement	Could benefit from Development	Capable and Effective	Role Model
You keep current with technical advances within your professional discipline; embrace and apply new techniques and practices
You willingly share your technical expertise; sought out as resource by others
You use expertise to identify issues and think through creative solutions to get a problem solved or objective accomplished.
You know how to produce high quality products/work.
You demonstrate mastery of the technical competencies required in your work.
Excellence	Needs Significant Improvement	Could benefit from Development	Capable and Effective	Role Model
You produce high quality work.
You take a lot of pride in your work.
You are planful and organized.
You can be counted on to add value wherever you are involved.
You keep yourself and others focused on constant improvement.
Empowering Others	Needs Significant Improvement	Could benefit from Development	Capable and Effective	Role Model
I set goals to allow the employees to have more autonomy over their work.
I give employees the authority to act on their own.
You listen to the ideas employees have for solving issues.
I give employees the resources they need to complete the job.
You recognize the accomplishments of employees when they complete important assignments.
Coaching	Needs Significant Improvement	Could benefit from Development	Capable and Effective	Role Model
You help employees to understand responsibilities, authority, and expectations.
You coach employees in how to strengthen knowledge and skills to improve work performance.
You address employee behavior problems effectively.
You provide clear, motivating, and constructive feedback.
You conduct regular performance appraisals and feedback.
Planning	Needs Significant Improvement	Could benefit from Development	Capable and Effective	Role Model
I set the appropriate sequence of tasks to ensure completion of the project.
I identify resource requirements that may impact the development of the 5-year plan.
You create to-do lists to make sure nothing is missed.
You make plans and follows through.
You work in an organized manner

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

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

    
    
52. Describe the greatest strengths of this person with regard to his/her overall effectiveness in performing his/her current responsibilities.
    
    
    
53. Describe the most important things this person could improve upon in order to increase his/her overall effectiveness in performing his/her current responsibilities.
    
    
    
54. Additional comments, if any for [Participant Name Here]'s assessment.