Mediation - 360 Degree Feedback Survey Sample #13

Instructions

You have been selected to provide valuable feedback for the manager listed above. Your insights are an important part of [Participant]'s leadership development process. This tool is designed to gather broad and comprehensive feedback on the core competencies and role responsibilities that are crucial for the continuous success of our organization.

When responding to the assessment form, please consider your experiences working with this individual over the past six to twelve months. Reflect on specific instances, interactions, and overall performance that you have observed. Your responses will be combined with feedback from other colleagues to create a holistic view of the manager's strengths and areas for improvement. This collective feedback will be used to guide their ongoing professional development.

Please be candid and constructive in your comments, as they will be shared anonymously with the manager. Your feedback will be instrumental in helping them understand their impact on the team and the organization, and in identifying opportunities for growth. We appreciate your time and effort in contributing to this important process.

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 .

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Mediation	Strongly Disagree	Disagree	Agree	Strongly Agree
Uses bridging language to connect divergent viewpoints and foster mutual understanding.
Explores underlying interests and motivations through thoughtful, open-ended questioning.
Stays focused on the meeting and does not get distracted by side issues.
Acts as an intermediary in the resolution of disputes.
Stages the release of information to align with emotional readiness and process flow.
Uses thematic grouping to help parties prioritize and sequence issues constructively.
Negotiates ground rules and confidentiality terms to support psychological safety and transparency.
Listens without judgment and reflects back concerns to show understanding and care.
Clarifies the purpose of private meetings before initiating them, ensuring all parties understand the intent.
Critical Thinking	Strongly Disagree	Disagree	Agree	Strongly Agree
Makes informed decisions supported by evidence.
Uses side-by-side comparisons to highlight trade-offs, risks, and potential impacts.
Demonstrates rigor in sourcing data that captures essential patterns and nuances.
Interprets data with caution, ensuring conclusions are grounded in fact.
Applies structured analysis to distill complex information into clear, actionable insights.
Objectives	Strongly Disagree	Disagree	Agree	Strongly Agree
Consistently provides me with timely feedback for improving my performance.
Communicates goals and objectives to employees.
Assures [Company] principles are understood, employed & pursued.
Able to organize work.
Ability to establish realistic goals.
Responsible	Strongly Disagree	Disagree	Agree	Strongly Agree
Responsible for setting the vision of the department.
Is a person you can trust.
Sets high personal standards of performance.
Sets a good example.
Holds herself / himself accountable to goals / objectives
Employee Development	Strongly Disagree	Disagree	Agree	Strongly Agree
Is aware of the department's training needs.
Is aware of employee training needs.
Uses cross-training to foster a culture of continuous learning and professional curiosity.
Ensures employees receive good training through the new hire onboarding program.
Offers regular workshops and seminars to help keep employees informed of the latest technology.

30. Describe the greatest strengths of this person with regard to his/her overall effectiveness in performing his/her current responsibilities.
    
    
    
31. Describe the most important things this person could improve upon in order to increase his/her overall effectiveness in performing his/her current responsibilities.
    
    
    
32. Overall, please rate the effectiveness of [Participant Name Here].
    

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

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