Persuasion and Influence - 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

Persuasion and Influence	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Understanding what others need.
Persuades others to consider alternative points of view.
Communicates effectively with others.
Ensures stakeholders are involved in the decision making process.
Able to express own goals and needs.
Time Management	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Provides accurate estimates for the amount of time needed to accomplish certain tasks.
Ensures timely completion of critical assignments.
Records time spent on work and non-work related items.
Delegates as many repetitive tasks as possible to maximize the amount of work being done.
Is proactive in addressing important issues.
Change Management	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Able to get team members to change their attitudes.
Effective in implementing new organizational vision and values.
Develops a strategy for implementing changes.
Supports new initiatives for organizational changes to improve effectiveness.
Works cooperatively with others to implement changes.
Client Focus	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Gives feedback to the client regularly.
Thoroughly understands the needs of the client.
Satisfies client needs.
Acts with integrity in all client interactions.
Tailors solutions to meet the specific needs of each client.
Conflict Management	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Seeks to avert the recurrence of conflict issues.
Reframes conflicts as opportunities to innovate and create new solutions to problems.
Settles disputes resulting in a win-win for both parties.
Settles disputes with agreement from both parties.
Identifies who holds the authority to make decisions.
Others	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Treats others with respect and dignity.
Is able to see issues from others' perspectives.
Constructively receives criticism and suggestions from others.
Forms working relationships with employees from other departments.
Respects the opinions of other employees.
Cultural Awareness	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Values the opinions of diverse groups and individual.
Is sensitive to the similarities and differences that exist between cultures.
Acknowledges their own biases in cultural interactions.
Is open and honest in communications with individuals from other cultures.
Supports and mentors others that may have different cultural backgrounds.
Fiscal Management	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Develops of the department's annual budget.
Develops budgets and plans for various programs and initiatives.
Monitors spending.
Keeps excellent records for financial transparency.
Effectively manages appropriations, reporting, purchases, expenditures, payrolls, and staff.
Global Perspective	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Is able to work with individuals having different backgrounds and cultures.
Exemplifies the skills of a global worker.
Communicates effectively on a multi-lingual basis.
Considers customers point of view when making decisions.
Creates an environment where individual differences are valued and supported.

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

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

    
    
47. Strengths
    
    
    
48. Areas for Development
    
    
    
49. Please give any final comments or suggestions for [Participant Name Here]'s assessment.