Passion to Learn - 360 Degree Feedback Survey Sample #4

Dear Employee:

Welcome to our 360-Degree Feedback self-assessment questionnaire. Our objective is to provide feedback which will help advance your leadership skills and capabilities. We are asking you to take time to respond to this survey to help us identify areas where you are doing well and where you have opportunities to do better. Others will also complete the questionnaire to provide you with feedback.

We have developed this survey with questions tailored for your position in the department to provide you with an opportunity to rate many facets of your leadership performance.

Please be honest, constructive and thoughtful in your responses. The results of this survey will be used to help drive our future success. If you have any questions about the process please contact [Contact Person].

Please ensure that your submission is made between . The survey will only be available during these dates.

Thank you for your participation in the survey. We look forward to seeing the analysis of your responses and we are hoping for 100% participation.

Management Team

Instructions:
Please complete the items below and press the submit button at the end of the survey. If you need multiple sessions to complete the survey, please click the "Submit" button at the end of each session to save your responses. Please feel free to skip any items that you do not wish to respond to. Keep in mind that your responses help us to become a better place to work. So, you are encouraged to respond to all items on the questionnaire.

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Passion To Learn	Needs Significant Development 1	2	Capable and Effective 3	4	Role Model 5
You recognize own areas for development and consciously seek assignments that will provide practice in areas of developmental need.
You constantly enhance product knowledge through experimentation and play.
You critique own performance and learn from experience as a source of continuous improvement.
You actively seek to learn by asking questions and listening to all store associates.
You hold self and associates accountable for goal achievement.
Cultural Awareness	Needs Significant Development 1	2	Capable and Effective 3	4	Role Model 5
You encourage a work environment where individual differences are valued.
You treat others with dignity and respect.
You seek out different viewpoints and benefits from different perspectives.
You maintain an inclusive work environment that maximizes the talents of others in achieving goals.
You respect others regardless of age, race, gender, nationality, or disability.
Bias for Action	Needs Significant Development 1	2	Capable and Effective 3	4	Role Model 5
You complete a large volume of work.
You coach others to foster an environment which can adapt quickly and willingly to rapid change.
You encourage risk taking and experimentation to improve performance
You project a "can-do" attitude when interfacing with peers, subordinates and customers(especially during difficult and challenging times).
You motivate others to achieve or exceed goals
Performance	Needs Significant Development 1	2	Capable and Effective 3	4	Role Model 5
You work effectively in the department.
You are effective in performing your job.
You have great overall performance
You are able to organize work.
You effectively organize resources and plans
Flexibility	Needs Significant Development 1	2	Capable and Effective 3	4	Role Model 5
You are willing to try new ideas.
You are effective in incorporating new ideas.
You implement changes as a result of having listened to employees
You can handle changes without complaining.
You identify new opportunities to achieve goals
Adaptability	Needs Significant Development 1	2	Capable and Effective 3	4	Role Model 5
You are proactive and takes steps to prepare for changes in the workplace.
You perform a wide range of tasks, respond to changes in direction and priorities and accept new challenges, responsibilities, and assignments.
You learn from personal experiences and/or mistakes.
You are able to recognize the potential benefits of change, and create an infrastructure which supports change.
You are able to quickly learn new ways of performing your job.
Problem Solving	Needs Significant Development 1	2	Capable and Effective 3	4	Role Model 5
You are able to solve problems at root cause rather than at symptom level.
You work cooperatively with others to solve problems.
You are a good problem solver and decision maker
You identify and assess all potential responses to a problem.
You are able to balance the needs of different people in a solution to a problem.
Initiative	Needs Significant Development 1	2	Capable and Effective 3	4	Role Model 5
You immediately work to complete goals well before your deadline.
You prepare for unexpected contingencies.
You take the initiative to change the direction or course of events.
You take action without being asked.
You coach others to foster an environment which can adapt quickly and willingly to rapid change.
Results Oriented	Needs Significant Development 1	2	Capable and Effective 3	4	Role Model 5
You stay focused on meeting the needs of customers.
You work toward achievement of goals even when confronted with obstacles.
You help others when free-time is available.
You encourage a high-energy, fun work environment and coaches others on how to do the same
You inspire and motivates co-workers to be productive and energetic at work
Safety	Needs Significant Development 1	2	Capable and Effective 3	4	Role Model 5
You seek to reduce the likelihood of accidents.
You are not afraid to question a potential safety issue observed in the workplace.
You perform work safely.
You work to implement corrective safety measures.
You support our company's safety programs.
Responsible	Needs Significant Development 1	2	Capable and Effective 3	4	Role Model 5
You work in a way that makes others want to work with you.
You set a good example
You complete assigned work tasks.
You set high personal standards of performance.
You act as a resource without removing individual responsibility.
Coaching	Needs Significant Development 1	2	Capable and Effective 3	4	Role Model 5
You conduct regular performance appraisals and feedback.
You address employee behavior problems effectively.
You coach employees in how to strengthen knowledge and skills to improve work performance.
You develop the skills and capabilities of others.
You help employees to understand responsibilities, authority, and expectations.
Partnering/Networking	Needs Significant Development 1	2	Capable and Effective 3	4	Role Model 5
You seek to reduce institutional roadblocks to information sharing.
You build alliances between departments and teams.
You support and encourage relationships that are created by diverse team members.
You create the conditions for partnerships to grow and develop.
You partner with peers to obtain influence within the Company.

66. On a scale of Excellent to Poor, how would you rate your overall employment with [Company] and why?
    

    -Excellent -Good -Average -Poor




67. Would you refer others who are seeking employment to [Company]?
    Yes No
    
    Please provide explanation:
    
    


68. If you had an opportunity to make any change you wanted to make [Company] a better place to work, what one improvement would you make?
    
    
    


69. What changes do you see [Company] making in order to raise the standards?
    
    


70. I feel good about my continued employment with [Company].
    Yes No
    
    If no, please provide explanation:
    
    
    


71. What do you like best about working for [Company]?
    
    


72. What do you like least about working for [Company]? How could it be improved?
    


93. Use the space below to enter any final comments you would like to be noted: