Mediation- 360 Degree Feedback Survey Sample #12

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

• Refrains from using confidential information to influence or pressure either party.
• Evaluates the relevance and sensitivity of information before sharing it with other parties.
• Explores underlying interests and motivations through thoughtful, open-ended questioning.
• Determines the relevant positions taken by each side.
• Identifies procedural issues that may impact the mediation.

Needs Improvement		Fully Proficient		Excels/ Role Model
Click this box to make your rating

Comments:

Empowering Others

• Encourages employees to take on greater responsibilities.
• Coordinates the knowledge, skills and resources of others to accomplish more in the department.
• Encourages employees to make informed decisions based on their own judgment and reasoning.
• Provides support and resources needed to accomplish goals.
• Gives employees the resources they need to complete the job.

Needs Improvement		Fully Proficient		Excels/ Role Model
Click this box to make your rating

Comments:

Continual Learning

• Views setbacks as opportunities to learn from.
• Takes the initiative to learn new skills.
• Pursues self-improvement through continual learning.
• Takes charge of their training and skills enhancement.
• Improves on their skill sets.

Needs Improvement		Fully Proficient		Excels/ Role Model
Click this box to make your rating

Comments:

Emotional Intelligence

• Is attentive to emotional cues and interprets others' feelings correctly.
• Helps employees to resolve conflicts, communicate clearly, and work together to solve problems.
• Able to understand others' points of view.
• Helps to make decisions and solve problems using knowledge about how others will react in certain situations.
• Is able to manage their own emotions.

Needs Improvement		Fully Proficient		Excels/ Role Model
Click this box to make your rating

Comments:

Project Management

• Initiates large projects.
• Locates the financial resources to budget for the project.
• Changes the implementation of specific phases of the project to mitigate certain risks.
• Anticipates potential problems and institutes controls and contingency plans to address them.
• Understands what software tools are available to be used to manage the project.

Needs Improvement		Fully Proficient		Excels/ Role Model
Click this box to make your rating

Comments:

Initiative

• Acts quickly when an opportunity becomes available.
• Leads pilots or experiments that result in scalable improvements.
• Immediately works to complete goals well before their deadline.
• Independently seeks out new learning opportunities to improve their skills.
• Initiates policy or process changes that become best practices across departments.

Needs Improvement		Fully Proficient		Excels/ Role Model
Click this box to make your rating

Comments:

Achievement

• Tracks and evaluates team efforts to align actions with long-term strategic objectives.
• Executes tasks with precision and speed.
• Maintains a proactive, fast-paced approach to problem-solving and decision-making.
• Makes a plan for getting things done and drives execution of the strategic plan, actively supporting or leading initiatives to closure.
• Commits to methodical execution, ensuring accountability and sustainable progress toward objectives.

Needs Improvement		Fully Proficient		Excels/ Role Model
Click this box to make your rating

Comments:

Strengths


Areas for Development


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