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.

---

Passion To Learn	Needs Significant Development 1	2	Capable and Effective 3	4	Role Model 5
You demonstrate a willingness to participate in continuing education courses.
You take advantage of training opportunities when they arise.
You will participate in training classes even if offered outside of normal working hours.
You enhance your value to the company through additional training and development.
You inspire others to learn new things.
Cultural Awareness	Needs Significant Development 1	2	Capable and Effective 3	4	Role Model 5
You avoid referring to stereotypes about others from different cultures.
I am an advocate for others with different cultural backgrounds.
You understand what customs and etiquette are important for individuals from other cultures.
I view diversity as a strength, not as an issue.
You seek out different viewpoints and benefits from different perspectives.
Bias for Action	Needs Significant Development 1	2	Capable and Effective 3	4	Role Model 5
You complete work on time
You encourage risk taking and experimentation to improve performance
You complete a large volume of work.
You convey a sense of urgency about addressing problems and opportunities
You project a "can-do" attitude when interfacing with peers, subordinates and customers(especially during difficult and challenging times).
Performance	Needs Significant Development 1	2	Capable and Effective 3	4	Role Model 5
You shown significant improvement in job performance.
You have great overall performance
You listen and respond to issues and problems
You produce quality
You are able to organize work.
Flexibility	Needs Significant Development 1	2	Capable and Effective 3	4	Role Model 5
You are effective in incorporating new ideas.
You work effectively during periods of change.
You are open to alternative ways to accomplish goals
You adapt to new organizational structures, policies, or procedures.
You act decisively in frequently changing and uncertain environment.
Adaptability	Needs Significant Development 1	2	Capable and Effective 3	4	Role Model 5
You are willing to change ideas or perceptions based on new information or contrary evidence which is presented.
You respond quickly to new information.
You are open to change and adjusts plans when needed.
You are able to adjust to changing environments.
You are effective in working with different personnel of the team.
Problem Solving	Needs Significant Development 1	2	Capable and Effective 3	4	Role Model 5
You identify fresh approaches and shows a willingness to question traditional assumptions.
You identify and assess all potential responses to a problem.
You find creative ways to get things done with limited resources.
You actively seek the root cause of a problem.
You work cooperatively with others to solve problems.
Initiative	Needs Significant Development 1	2	Capable and Effective 3	4	Role Model 5
I am able to initiate work on projects independently without direct supervision.
You immediately work to complete goals well before your deadline.
You immediately inform the HR Department of any personnel complaints or issues.
I take charge when there is a crisis.
I update the documentation as soon as the situation changes.
Results Oriented	Needs Significant Development 1	2	Capable and Effective 3	4	Role Model 5
You do not become distracted by non-issues or interruptions.
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
You stay focused on meeting the needs of customers.
You direct team in prioritizing daily work activities
Safety	Needs Significant Development 1	2	Capable and Effective 3	4	Role Model 5
You mitigate hazards and safety issues that arise.
You develop safety guidelines for the department.
You participate in safety training when available.
You support safety programs and procedures.
You commit adequate resources toward safety measures.
Responsible	Needs Significant Development 1	2	Capable and Effective 3	4	Role Model 5
You complete assigned work tasks.
Your behavior is ethical and honest.
You work in a way that makes others want to work with you.
You are responsible for setting the vision of the department.
You set a good example.
Coaching	Needs Significant Development 1	2	Capable and Effective 3	4	Role Model 5
You conduct regular performance appraisals and feedback.
You provide clear, motivating, and constructive feedback.
You develop the skills and capabilities of others.
You coach employees in how to strengthen knowledge and skills to improve work performance.
You help employees to maintain high personal standards.
Partnering/Networking	Needs Significant Development 1	2	Capable and Effective 3	4	Role Model 5
You forge mutually beneficial relationships between individuals with diverse backgrounds.
You create value within the Company by building networks.
You develop a sense of trust in subordinates so they can freely interact and share information with others.
You create the conditions for partnerships to grow and develop.
You promote the understanding of how the department affects the organization overall.

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: