Mediation- 360 Degree Feedback Survey Sample #4

Dear Employee:


Welcome to our 360-Degree Feedback Assessment of [Participant Name]. Our objective is to provide feedback which will help advance his/her leadership skills and capabilities. We are asking you to take time to respond to this survey to help us identify where we are doing well and where we have opportunities to do better.

We have developed this survey with questions tailored for [Participant Name]'s position in the department to provide you with an opportunity to anonymously rate many facets of his/her leadership performance. The survey will assess what you value most in their leadership skills and allow you to make positive suggestions for improvement.

Please be honest, constructive and thoughtful in your responses. The results of this survey will be used to help drive our future success. 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



Instructions:
Please complete the items below and press the submit button at the end of the survey. If you need multiple sessions to complete the survey, please click the "Submit" button at the end of each session to save your responses. Please feel free to skip any items that you do not wish to respond to. Keep in mind that your responses help us to become a better place to work. So, you are encouraged to respond to all items on the questionnaire.

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Mediation	Needs Significant Development 1	2	Capable and Effective 3	4	Role Model 5
Poses respectful, curiosity-driven questions to help parties articulate concerns and clarify misunderstandings.
Helps disputing parties arrive at a mutually acceptable solution to their conflict.
Encourages empathy, active listening, and reframing of positions into shared interests.
Invites reflection through nonjudgmental questions that surface unspoken needs and assumptions.
Adapts the mediation structure in real time based on emerging dynamics and party feedback.
Negotiation	Needs Significant Development 1	2	Capable and Effective 3	4	Role Model 5
Able to say "no" when necessary to effectively execute business strategy and meet long-term objectives.
Is aware of and manages own emotions and understands the emotions of others which helps in navigating tense situations and in finding common ground.
Clearly articulates points and actively listens to the others to ensure that both sides understand each other's needs and concerns.
Knows where to stand firm and where to compromise.
Alters plans to respond to immediate challenges.
Trustworthy	Needs Significant Development 1	2	Capable and Effective 3	4	Role Model 5
Demonstrates congruence between statements and actions.
Communicates an understanding of the other person's interests, needs and concerns.
Delivers on promises made.
Is a person you can trust.
Seeks to mitigate grievances by clarifying intentions and finding suitable remedies.
Emotional Intelligence	Needs Significant Development 1	2	Capable and Effective 3	4	Role Model 5
Is attentive to emotional cues and interprets others' feelings correctly.
Helps employees to resolve conflicts, communicate clearly, and work together to solve problems.
Accurately perceives the emotional reactions of others.
Is able to control their own emotions.
Is able to express themselves clearly.
Persuasion and Influence	Needs Significant Development 1	2	Capable and Effective 3	4	Role Model 5
Confronts individuals with information about their beliefs and values.
Prepares visual aids, storytelling elements, or analogies in advance to reinforce complex points.
Moves employees from being afraid of change to having a growth-oriented mindset, sparking more employee engagement.
Uses logic and reason to persuade and influence others.
Persuades others to consider alternative points of view.
Change Management	Needs Significant Development 1	2	Capable and Effective 3	4	Role Model 5
Helps employees to view change as something positive for the organization.
Establishes the necessary direction to guide the changes.
Adjusts leadership approach to align with evolving circumstances.
Helps employees overcome their resistance to change.
Is proactive in planning for multiple possible future conditions be be prepared for all possible scenarios.
Technology Use/Management	Needs Significant Development 1	2	Capable and Effective 3	4	Role Model 5
Supports employee training and development initiatives regarding implementation of technology.
Maximizes the use of new technology to deliver products and services.
Identifies gaps between actual and needed technical competencies and provides recommendations for required training.
Understands and is committed to implementing new technologies.
Adopts the implementation of new technology into the workplace.
Employee Development	Needs Significant Development 1	2	Capable and Effective 3	4	Role Model 5
Encourages employees to take the initiative and contribute ideas that influence team or organizational outcomes.
Promotes employees for the right reasons.
Offers training that is relevant for the position.
Is a mentor to others.
Is committed to offering the training our department needs.
Accountability	Needs Significant Development 1	2	Capable and Effective 3	4	Role Model 5
Continues to work diligently on a problem despite setbacks.
Accepts accountability for their work.
Takes responsibility for the team's actions and results.
Can be counted on to do their role well.
Acknowledges errors and takes the steps necessary to rectify them.

46. On a scale of Excellent to Poor, how would you rate your overall employment with [Company] and why?
    

    -Excellent -Good -Average -Poor




47. Would you refer others who are seeking employment to [Company]?
    Yes No
    
    Please provide explanation:
    
    
    
48. If you had an opportunity to make any change you wanted to make [Company] a better place to work, what one improvement would you make?
    
    
    
49. What changes do you see [Company] making in order to raise the standards?
    
    
    
50. I feel good about my continued employment with [Company].
    Yes No
    
    If no, please provide explanation:
    
    
    
51. What do you like best about working for [Company]?
    
    
    
52. What do you like least about working for [Company]? How could it be improved?
    
    
    
93. Use the space below to enter any final comments you would like to be noted: