Others- 360 Degree Feedback Survey Sample #12

360 Feedback Survey

Instructions

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 comment section for that competency. 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.

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

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

Others

• Treats others with respect and dignity.
• Is able to see issues from others' perspectives.
• Includes others in the decision making processes.
• Forms working relationships with employees from other departments.
• Helpful

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

Comments:

Emotional Intelligence

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

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

Comments:

Quality

• Evaluates and improves the quality of services and products.
• Committed to the improvement of the quality of services and products.
• Assesses strengths and weaknesses of various quality initiatives.
• Communicates quality standards clearly.
• Effectively coordinates with other departments to improve quality.

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

Comments:

Achievement

• Created impactful reports for the re-organization committee.
• Driven to complete goals despite obstacles that may arise.
• Takes calculated risks.
• Met required benchmarks for the position.
• Completes work to a high technical standard

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

Comments:

Responsible

• Works in a way that makes others want to work with her/him.
• ...takes personal responsibility for results.
• Sets high personal standards of performance.
• Sets a good example.
• Is a person you can trust.

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.