Performance - 360 Degree Feedback Survey Sample #5

360-Degree Assessment Survey

Dear Employee:

Thank you for participating in a 360-degree feedback assessment. In this process, you will complete a self-assessment questionnaire (below). You will also receive feedback from others including your manager, peers and direct reports. As you respond, please respond using just your experiences in the past 12 months. Rate each item using the scale shown. 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 you at the conclusion of this assessment to help guide your ongoing professional 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

Performance	Role Model	Capable and Effective	Somewhat Effective	Needs Development
You work effectively in the department.
You are able to organize work.
You are effective in performing your job.
You listen and respond to issues and problems
You work well in this position.
Developing Others	Role Model	Capable and Effective	Somewhat Effective	Needs Development
You create opportunities for professional development.
You recognize and celebrates accomplishments of others.
You develop employees by offering and encouraging them to take on new or additional responsibilities.
You create a work environment that fosters positive feedback to employees.
You support the successes of other employees.
Conflict Management	Role Model	Capable and Effective	Somewhat Effective	Needs Development
I seek to achieve mutually acceptable outcomes.
You use structured frameworks for resolving conflicts, such as mediation or facilitated discussions.
You settle disputes with agreement from both parties.
I address contentious issues earlier rather than later.
You help others avoid misperceptions about issues.
Strategic Focus	Role Model	Capable and Effective	Somewhat Effective	Needs Development
You determine the best strategy for achieving elevated levels of performance.
You avoid complacency and strives to be ahead of changes in the business environment.
You are able to formulate strategy at the corporate level.
I ensure adherence to the strategy to sustain achievement of targeted levels of organizational performance.
I exploit resources and capabilities to strategically increase production and responsiveness.
Fiscal Management	Role Model	Capable and Effective	Somewhat Effective	Needs Development
You effectively manage appropriations, reporting, purchases, expenditures, payrolls, and staff.
You keep excellent records for financial transparency.
You develop of the department's annual budget.
You develop budgets and plans for various programs and initiatives.
You ensure others follow the correct rules and regulations on fiscal matters.
Planning	Role Model	Capable and Effective	Somewhat Effective	Needs Development
I make strategic and tactical decisions to guide the logistics process.
You have developed an effective strategic plan.
I divide complex tasks into smaller steps to measure progress toward a goal.
You set up and monitor timeframes and plans
I can accurately estimate the amount of materials/supplies needed for the project.

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

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

    
    
32. Strengths
    
    
    
33. Areas for Development
    
    
    
34. Please give any final comments or suggestions for [Participant Name Here]'s assessment.