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
Encourages others to achieve high quality standards.
Encourages employees to produce the best quality products.
Always strives to produce the highest quality work products.
Holds employees accountable for their quality of work.
Encourages others to produce the highest quality work products.
Reflects on what is working and what could be improved.
Change Management	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Effective in implementing new organizational vision and values.
Is a leading force driving changes.
Able to get team members to change their attitudes.
Supports new initiatives for organizational changes to improve effectiveness.
Supports the Company's efforts to implement changes.
Facilitates change with minimal resistance.
Responsible	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Is a person you can trust.
Sets high personal standards of performance.
Behavior is ethical and honest.
Works in a way that makes others want to work with her/him.
Holds herself / himself accountable to goals / objectives
...takes personal responsibility for results.
Developing Others	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Assigns tasks and responsibilities to develop skills of others.
Develops employees by offering and encouraging them to take on new or additional responsibilities.
Sets performance objectives for subordinates that encourages development opportunities.
Supports the successes of other employees.
Encourages employees through recognition of positive changes in behavior.
Is open to receiving feedback.
Coaching	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Helps employees to maintain high personal standards.
Coaches employees in how to strengthen knowledge and skills to improve work performance.
Provides clear, motivating, and constructive feedback.
Helps employees to understand responsibilities, authority, and expectations.
Conducts regular performance appraisals and feedback.
Develops the skills and capabilities of others.
Others	Role Model	Capable and Effective	Somewhat Effective	Needs Development
...treats others with respect and dignity.
Is able to see issues from others' perspectives.
Able to see issues from others' perspectives.
Works across boundaries within the organization.
Constructively receives criticism and suggestions from others.
Includes others in the decision making processes.
Company	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Impresses upon others the important aspects of [Company].
Understands how decisions impact other business units beyond their immediate department of work group.
Expresses loyalty and dedication to [Company] in interactions with others.
Follows existing procedures and processes.
Attends [Company] gatherings and social events.
Understands the use of [Company] products and services.
Global Perspective	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Builds working relationships with others across cultures.
Communicates effectively on a multi-lingual basis.
Exemplifies the skills of a global worker.
Facilitates open communication with individuals from other countries.
Demonstrates working knowledge of global transactions.
Aligns personal vision with global strategies.

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.