Quality - 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

Quality	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Corrects issues in a timely manner.
Encourages others to achieve high quality standards.
Encourages others to produce the highest quality work products.
Encourages employees to produce the best quality products.
Always strives to produce the highest quality work products.
Analyze what occurred and re-adjusts accordingly when goals are not met.
Change Management	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Effective in dealing with ambiguous and challenging situations.
Supports new initiatives for organizational changes to improve effectiveness.
Assists others in understanding changes to the organization.
Works cooperatively with others to implement changes.
Addresses organizational and departmental resistance to changes.
Supports the Company's efforts to implement changes.
Responsible	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Acts as a resource without removing individual responsibility.
...takes personal responsibility for results.
Works in a way that makes others want to work with her/him.
Sets a good example
Sets high personal standards of performance.
Completes assigned work tasks.
Developing Others	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Supports the successes of other employees.
Develops employees by offering and encouraging them to take on new or additional responsibilities.
Assesses employees' developmental needs.
Encourages employees through recognition of positive changes in behavior.
Recognizes and celebrates accomplishments of others.
Tries to ensure employees are ready to move to the next level.
Coaching	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Helps employees to understand responsibilities, authority, and expectations.
Coaches employees in how to strengthen knowledge and skills to improve work performance.
Develops the skills and capabilities of others.
Addresses employee behavior problems effectively.
Provides clear, motivating, and constructive feedback.
Meets regularly with employees to coach them on areas that will enhance their performance
Others	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Works across boundaries within the organization.
Helpful
Respects the opinions of other employees.
Includes others in the decision making processes.
Works effectively with people from other departments.
Able to see issues from others' perspectives.
Company	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Understands how decisions impact other business units beyond their immediate department of work group.
Follows existing procedures and processes.
Understands the use of [Company] products and services.
Expresses loyalty and dedication to [Company] in interactions with others.
Attends [Company] gatherings and social events.
Understands the "basics" as to how [Company] functions/operates.
Global Perspective	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Attends training seminars and conferences to increase skills in working with others globally.
Aligns personal vision with global strategies.
Communicates effectively on a multi-lingual basis.
Able to work with others from different cultures and countries.
Accepts setbacks and challenges in foreign markets as improvement opportunities
Works well with others from different cultural backgrounds.

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

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

    
    
50. Strengths
    
    
    
51. Areas for Development
    
    
    
52. Please give any final comments or suggestions for [Participant Name Here]'s assessment.