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Mediation- 360 Degree Feedback Survey Sample #2





Surveys Measuring Mediation:
Survey 1 (4-point scale; Competency Comments)
Survey 2 (4-point scale; Competency Comments)
Survey 3 (5-point scale; Competency Comments)
Survey 4 (5-point scale; radio buttons)
Survey 5 (4-point scale; words)
Survey 6 (4-point scale; words)
Survey 7 (5-point scale; competency comments; N/A)
Survey 8 (3-point scale; Agree/Disagree words; N/A)
Survey 9 (3-point scale; Strength/Development; N/A)
Survey 10 (Comment boxes only)
Survey 11 (Single rating per competency)
Survey 12 (Slide-bar scale)
Survey 13 (4-point scale; numbers; floating anchors)
Survey 14 (4-point scale; N/A)
Instructions

You have been selected to provide feedback on the employee listed above. Your feedback is an important part of our company's leadership development process and this survey is intended to gather broad feedback in the core competencies and role responsibilities that are important for the on-going success of our organization.

In responding to the questions below, think about your experiences working with this employee over the last twelve months and the goals they were asked to achieve. 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 discussed with the employee to foster growth and on-going development.

Competencies Included:
Mediation, Clarity, Negotiation, Flexibility, Integrity, Emotional Intelligence, Performance, Problem Solving, Entrepreneurship
Sample Result Document:
Sample Results
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 between . The survey will only be available during these dates.
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Mediation

Clear
Strength
Capable
and
Effective
Could
Benefit from
Development
Needs
Significant
Improvement
  1. Checks for comfort and readiness before initiating sensitive discussions, especially in caucus.
  1. Adapts the mediation process to facilitate changing circumstances.
  1. Reframes language or tone to maintain constructive dialogue.
  1. Uses open-ended and targeted questions to elicit relevant facts, perspectives, and interests.
  1. Clearly communicates what will remain confidential and what may be shared with consent.
What are your suggestions for how [Participant Name] can make improvements
in Mediation?

Clarity

Clear
Strength
Capable
and
Effective
Could
Benefit from
Development
Needs
Significant
Improvement
  1. Avoids stating unclear or conflicting goals.
  1. Clearly explains responsibilities to individuals.
  1. Avoids creating ambiguity or mixed messages.
  1. Clearly explains the vision and goals of the company.
  1. Attends to the important details of a job or task.
What are your suggestions for how [Participant Name] can make improvements
in Clarity?

Negotiation

Clear
Strength
Capable
and
Effective
Could
Benefit from
Development
Needs
Significant
Improvement
  1. Collects information from various stakeholders, each with their own viewpoints, data, and interests.
  1. Is an effective negotiator, fostering positive relationships and achieving good outcomes.
  1. Able to express themselves in a clear, convincing, and logical manner.
  1. Firmly believes the company is making the best offer.
  1. Manages emotions to reduce the impact of negativity.
What are your suggestions for how [Participant Name] can make improvements
in Negotiation?

Flexibility

Clear
Strength
Capable
and
Effective
Could
Benefit from
Development
Needs
Significant
Improvement
  1. Experiments with new ideas to create innovative solutions to issues.
  1. Adjusts approaches to fit unique scenarios.
  1. Allows workflows to evolve with the employees' creativity.
  1. Open to adapting thoughts, behaviors, and strategies in response to evolving situations and new information.
  1. Innovates skills and modifies behaviors to remain flexible in addressing important issues.
What are your suggestions for how [Participant Name] can make improvements
in Flexibility?

Integrity

Clear
Strength
Capable
and
Effective
Could
Benefit from
Development
Needs
Significant
Improvement
  1. Prioritizes accountability to ensure that actions align with the company's values and ethical principles.
  1. Is transparent, open and honest about their actions and decisions.
  1. Creates a Code of Conduct to guide employees on the company's expectations regarding ethics and integrity.
  1. Handles difficult interactions with grace to set a positive example for others, promoting a culture of respect and professionalism.
  1. Is a reliable and dependable partner.
What are your suggestions for how [Participant Name] can make improvements
in Integrity?

Emotional Intelligence

Clear
Strength
Capable
and
Effective
Could
Benefit from
Development
Needs
Significant
Improvement
  1. Is able to control their own emotions.
  1. Accurately perceives the emotional reactions of others.
  1. Able to understand others' points of view.
  1. Is able to manage their own emotions.
  1. Helps employees to resolve conflicts, communicate clearly, and work together to solve problems.
What are your suggestions for how [Participant Name] can make improvements
in Emotional Intelligence?

Performance

Clear
Strength
Capable
and
Effective
Could
Benefit from
Development
Needs
Significant
Improvement
  1. ...Overall Performance
  1. Sets a high standard for job performance.
  1. ...Produce Quality
  1. Effective in performing his/her job.
  1. Shown significant improvement in job performance.
What are your suggestions for how [Participant Name] can make improvements
in Performance?

Problem Solving

Clear
Strength
Capable
and
Effective
Could
Benefit from
Development
Needs
Significant
Improvement
  1. Develops a schedule and gathers the necessary materials and tools.
  1. Has the ability to compare "best practice" performance to current situation and affect improvements.
  1. Conducts a thorough and careful analysis of the underlying causes of problems.
  1. Involves team members in conversations about the problem to improve communication and teamwork, which helps in finding and applying the best solutions.
  1. Determines what facts are relevant.
What are your suggestions for how [Participant Name] can make improvements
in Problem Solving?

Entrepreneurship

Clear
Strength
Capable
and
Effective
Could
Benefit from
Development
Needs
Significant
Improvement
  1. Exhibits determination and passion in completion of goals.
  1. Excellent at managing relationships with stakeholders.
  1. Balances risks and rewards when making decisions.
  1. Able to adapt the department to changing business demands and climate.
  1. Takes the initiative to complete tasks.
What are your suggestions for how [Participant Name] can make improvements
in Entrepreneurship?


  1. Strengths


  2. Areas for Development


  3. Please give any final comments or suggestions for [Participant Name Here]'s assessment.