Mediation- 360 Degree Feedback Survey Sample #8

Instructions

You have been selected to provide feedback for the manager listed above. Your feedback is an important part of 's leadership development process. This tool 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 assessment form, please think about your experiences working with this individual during the last six to twelve months. Your responses will be merged with other people's feedback and presented to to guide them in their on-going development. Comments will be shared anonymously, as written, with the manager.

Method of use: As part of the review process, managers will receive feedback from peers and staff. It is recognized that not all participants will be able to assess an individual's performance in all areas. The feedback received will be utilized as input to the manager's performance and on-going development plan.

You may sign out at any time by pressing the Save button at the end of the form and then closing your browser. You may return later to pick up where you left off. When you are done, press the Complete button.



Please complete your response by .

Edit this Survey

Would you like to edit this survey? Click here to begin.

Mediation	Agree	Unsure	Disagree	N/A
Invites quieter voices into the conversation, ensuring equitable participation.
Sequencing issues to build momentum and address high-stakes topics at the right time.
Identifies gaps in understanding and seeks additional input to complete the picture.
Introduces breaks or breathing space when emotional fatigue sets in.
Conducts a conflict assessment and risk analysis to determine the best course of action.
Employee Relations	Agree	Unsure	Disagree	N/A
Collaborates with facilities and safety teams to maintain clean, functional, and hazard-free workspaces.
Builds trust by treating employees with fairness, dignity, and genuine consideration.
Support self-directed work, allowing teams to set goals and determine the best path to achieve them.
Uses structured onboarding to give employees clarity on company values, behavioral expectations, and team dynamics.
Is effective in handling grievance procedures and resolving disputes.
Attitude	Agree	Unsure	Disagree	N/A
Encourages others to overcome resistance to change.
Is self-confident and willing to take risks to advance important projects.
Deflects praise with grace and redirects attention to collaborative effort.
Uses affirming language that emphasizes strengths, possibilities, and momentum.
Proactively seeks feedback to refine outcomes, not out of obligation but a desire to elevate quality.
Supervisory Skills	Agree	Unsure	Disagree	N/A
Maintains professional interactions with peers, customers, and employees.
Reviews performance against established measures.
Knows the best ways to communicate effectively with different types of employees.
Prioritizes coaching and constructive feedback to correct behavior.
Facilitates open communication between employees.
Administrative Skill	Agree	Unsure	Disagree	N/A
Communicates effectively both in writing and verbally.
Organizes schedules, including departure and arrival times, check-in details, and reservation confirmations.
Provides assistance to others in obtaining passports, visas, and other international travel documents.
Books travel arrangements by purchasing tickets for transportation and securing accommodations.
Analyzes financial transactions and their impacts in various reports.
Commitment To Result	Agree	Unsure	Disagree	N/A
Able to focus on a task even when working alone.
Creates a sense of urgency among the store team members to complete activities, which drive sales.
Encourages commitment in others to obtain results.
Conveys strong sense of own pride in Company to associates by creating a shared vision around sales and customer service.
Maintains persistence and dedication to achieving results.
Safety	Agree	Unsure	Disagree	N/A
Performs work safely.
Committed to safety in the workplace.
Seeks to reduce the likelihood of accidents.
Develops a culture of safety.
Encourages others to work safely.
Customer Focus	Agree	Unsure	Disagree	N/A
Responsive to customer needs.
Is committed to the success of the customer.
Builds products that meet the unique needs of each customer.
Creates customized solutions for the customer.
Focuses on providing excellent customer service.
Strategic Insight	Agree	Unsure	Disagree	N/A
Recognizes the needs of customers.
Implements long-term solutions to problems.
Understands the Company's strengths and weaknesses and uses this information to create optimal solutions to problems.
Analyzes records and reports to obtain insight into potential issues and trends.
Integrates financial, operational, and market data to guide strategic priorities and resource allocation.
Passion To Learn	Agree	Unsure	Disagree	N/A
Creates an environment that supports personal development and exploration.
Is open to feedback from others.
Takes advantage of training opportunities when they arise.
Is committed to enhancing their own knowledge and skills.
Constantly enhances product knowledge through experimentation and play.

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

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

    
    
52. Strengths
    
    
    
53. Areas for Development
    
    
    
54. Please give any final comments or suggestions for [Participant Name Here]'s assessment.