Others- 360 Degree Feedback Survey Sample #5

360-Degree Assessment Survey

Dear Employee:

Thank you for providing feedback for the recipient above. As you respond, please draw on your first-hand experience with this individual in the past 12 months. Rate each item using the scale shown. If you don't feel you have enough first-hand information to rate a certain item, please choose the Not Applicable option. Comments can be very helpful; at a minimum where you give a particularly high or low rating, please share your reasons in the Closing Comments section. Your responses will be compiled with feedback from others and presented to the recipient to help guide their ongoing development.

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.

Please ensure that your submission is made by .

Thank you for your participation in the survey.

Management Team

Others	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Works across boundaries within the organization.
Consistently demonstrates ability and willingness to trust others.
Constructively receives criticism and suggestions from others.
Supports the efforts of other employees in implementing solutions to problems.
Continual Improvement	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Looks for ways to expand current job responsibilities.
Analyzes processes to determine areas for improvement.
Searches for new methods, techniques, and processes that increase efficiency and reduce costs.
Looks for ways to improve work processes and procedures.
Cultural Awareness	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Is willing to include individuals with different cultural backgrounds on the team.
Treats others with dignity and respect.
Understands what customs and etiquette are important for individuals from other cultures.
Is open and honest in communications with individuals from other cultures.
Managing Performance	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Establishes standards for expected performance.
Sets long and short term goals.
Recognizes and values good performance.
Uses timely and appropriate corrective/disciplinary actions.
Quality	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Encourages employees to produce the best quality products.
Encourages others to produce the highest quality work products.
Holds employees accountable for their quality of work.
Encourages others to achieve high quality standards.
Time Management	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Prioritizes tasks to identify immediate and long-term objectives.
Keeps and maintains a To-Do list.
Does not procrastinate.
Focuses on tasks that have high priority.
Commitment To Result	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Committed to the team.
Encourages commitment in others to obtain results.
Willing to do whatever it takes-not afraid to have to put in extra effort.
Maintains persistence and dedication to achieving results.
Technical	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Uses expertise to identify issues and think through creative solutions to get a problem solved or objective accomplished.
Willingly shares information and expertise; sought out as resource by others
Willingly shares his/her technical expertise; sought out as resource by others
Is knowledgeable of procedures or systems necessary for the job.
Regulatory/Compliance	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Offers training to employees to ensure they are complying with regulations.
Complies with trade agreements affecting international companies.
Explains regulations and procedures to others as required.
Ensures regulations are followed as required.
Vision	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Leads employees in new directions.
Develops action plans to align his/her work with the goals of the organization
Demonstrates consistency between words and actions
Creates a common vision for others.

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

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

    
    
42. Strengths
    
    
    
43. Areas for Development
    
    
    
44. Please give any final comments or suggestions for [Participant Name Here]'s assessment.