Mediation- 360 Degree Feedback Survey Sample #11

360 Feedback Survey

Instructions

We appreciate you taking the time to provide valuable feedback for the individual mentioned above. As you respond, please draw on your first-hand experience with this individual in the past 12 months. Your insights are crucial in offering a comprehensive evaluation. Please rate each item using the scale provided. If you find that you do not have sufficient first-hand knowledge to rate a particular item, select the Not Applicable option.

In addition to the ratings, we encourage you to include comments where possible. These comments are particularly useful when you give a very high or very low rating, as they provide context and clarity regarding your assessment. Explaining your reasons in the comment section helps ensure that your feedback is constructive and actionable.

Your responses, combined with feedback from other contributors, will be compiled and presented to the individual. This collective feedback aims to support their continuous growth and development by highlighting strengths and identifying areas for improvement. Your thoughtful participation is essential in helping them achieve their full potential.

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.

To what extent does [Participant Name] exhibit the following ...

SELECT the rating that best reflects the employee's performance in the areas listed.

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Mediation

What does Mediation mean?
It means that ...

• You help identify general points or principles communicated by each party.
• I use thematic grouping to help parties prioritize and sequence issues constructively.
• You invite parties to suggest topics or concerns they would like to explore privately.
• You condense and summarize messages from each party.
• I address issues brought up by either side.

To what extent does this person exhibit Mediation?
Select from one of the ratings below.

Not Applicable or Unable to Judge

Poor does not perform to expected standards; often unable to complete tasks; does not seek help or advice

Minimal completes tasks only when pressured to do so; is satisfied with minimal progress; only does what is required

Average completes tasks easily; seeks to obtain maximal performance; willing to seek advice and help when needed

Role Model is a role model for others to follow; goes above and beyond what is expected; helps others

Organizational Fluency

What does Organizational Fluency mean?
It means that ...

• You are aware of other organizational cultures to compare/contrast with the current organizational culture.
• You are able to deal with sensitive issues with tact and professionalism.
• You are able to use corporate politics to advance department objectives.
• You understand departmental policies and procedures.
• You are able to explain departmental policies and procedures to others.

To what extent does this person exhibit Organizational Fluency?
Select from one of the ratings below.

Not Applicable or Unable to Judge

Poor does not perform to expected standards; often unable to complete tasks; does not seek help or advice

Minimal completes tasks only when pressured to do so; is satisfied with minimal progress; only does what is required

Average completes tasks easily; seeks to obtain maximal performance; willing to seek advice and help when needed

Role Model is a role model for others to follow; goes above and beyond what is expected; helps others

Decision Making

What does Decision Making mean?
It means that ...

• I understand how my decisions will affect others.
• I consider the ethical implications of decisions.
• I use simulations, role-playing, or scenario planning to explore outcomes before committing to a course of action.
• I make decisions that support the department's goals and objectives.
• You view the long and short-term impact of decisions.

To what extent does this person exhibit Decision Making?
Select from one of the ratings below.

Not Applicable or Unable to Judge

Poor does not perform to expected standards; often unable to complete tasks; does not seek help or advice

Minimal completes tasks only when pressured to do so; is satisfied with minimal progress; only does what is required

Average completes tasks easily; seeks to obtain maximal performance; willing to seek advice and help when needed

Role Model is a role model for others to follow; goes above and beyond what is expected; helps others

Delegation

What does Delegation mean?
It means that ...

• I identify interdependencies between tasks are delegated strategically.
• You encourage and empower others to use initiative in achieving goals and objectives.
• I trust employees to take on more responsibilities.
• I allow employees the space to manage their own workload effectively.
• You communicate expectations for assigned tasks.

To what extent does this person exhibit Delegation?
Select from one of the ratings below.

Not Applicable or Unable to Judge

Poor does not perform to expected standards; often unable to complete tasks; does not seek help or advice

Minimal completes tasks only when pressured to do so; is satisfied with minimal progress; only does what is required

Average completes tasks easily; seeks to obtain maximal performance; willing to seek advice and help when needed

Role Model is a role model for others to follow; goes above and beyond what is expected; helps others

Management

What does Management mean?
It means that ...

• I use delegation as a developmental tool, gradually increasing autonomy as competence grows.
• I evaluate workplace challenge and select the most effective course of action.
• You develop a coordinated implementation plan that sequences key elements of the resource allocation strategy.
• You openly admit errors and use them as learning opportunities for self and team.
• I delegate stretch assignments that foster skill growth and sustain motivation.

To what extent does this person exhibit Management?
Select from one of the ratings below.

Not Applicable or Unable to Judge

Poor does not perform to expected standards; often unable to complete tasks; does not seek help or advice

Minimal completes tasks only when pressured to do so; is satisfied with minimal progress; only does what is required

Average completes tasks easily; seeks to obtain maximal performance; willing to seek advice and help when needed

Role Model is a role model for others to follow; goes above and beyond what is expected; helps others

Innovation

What does Innovation mean?
It means that ...

• You are open to innovative ideas.
• I identify the opportunities created by innovations.
• You take risks to advance important ideas.
• You facilitate ongoing technical training and development to enable employees to contribute to innovative solutions.
• I determine how much risk the company is willing to take in implementing innovations to the products and services.

To what extent does this person exhibit Innovation?
Select from one of the ratings below.

Not Applicable or Unable to Judge

Poor does not perform to expected standards; often unable to complete tasks; does not seek help or advice

Minimal completes tasks only when pressured to do so; is satisfied with minimal progress; only does what is required

Average completes tasks easily; seeks to obtain maximal performance; willing to seek advice and help when needed

Role Model is a role model for others to follow; goes above and beyond what is expected; helps others

Managing Risk

What does Managing Risk mean?
It means that ...

• You take steps to minimize the impact/damage of the risk events.
• You have the knowledge and skills to accurately identify risks in the workplace.
• You create informative guides regarding potential risks and risky behaviors.
• I determine the potential financial impact of specific risks.
• You recognize that small changes may snowball into major events.

To what extent does this person exhibit Managing Risk?
Select from one of the ratings below.

Not Applicable or Unable to Judge

Poor does not perform to expected standards; often unable to complete tasks; does not seek help or advice

Minimal completes tasks only when pressured to do so; is satisfied with minimal progress; only does what is required

Average completes tasks easily; seeks to obtain maximal performance; willing to seek advice and help when needed

Role Model is a role model for others to follow; goes above and beyond what is expected; helps others

Strengths


Areas for Development


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