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
Always strives to produce the highest quality work products.
Reflects on what is working and what could be improved.
Encourages others to achieve high quality standards.
Corrects issues in a timely manner.
Encourages employees to produce the best quality products.
Holds employees accountable for their quality of work.
Change Management	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Works cooperatively with others to implement changes.
Inspires others to accept changes.
Facilitates change with minimal resistance.
Supports new initiatives for organizational changes to improve effectiveness.
Assists others in understanding changes to the organization.
Addresses organizational and departmental resistance to changes.
Responsible	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Sets a good example
Holds herself / himself accountable to goals / objectives
Sets high personal standards of performance.
Responsible for setting the vision of the department.
Sets a good example.
Completes assigned work tasks.
Developing Others	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Supports the successes of other employees.
Creates a work environment that fosters positive feedback to employees.
Tries to ensure employees are ready to move to the next level.
Assigns tasks and responsibilities to develop skills of others.
Encourages employees through recognition of positive changes in behavior.
Creates opportunities for professional development.
Coaching	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Conducts regular performance appraisals and feedback.
Develops the skills and capabilities of others.
Helps employees to maintain high personal standards.
Addresses employee behavior problems effectively.
Coaches employees in how to strengthen knowledge and skills to improve work performance.
Meets regularly with employees to coach them on areas that will enhance their performance
Others	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Helpful
Constructively receives criticism and suggestions from others.
...treats others with respect and dignity.
Able to see issues from others' perspectives.
Works effectively with people from other departments.
Consistently demonstrates ability and willingness to trust others.
Company	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Expresses loyalty and dedication to [Company] in interactions with others.
Understands the "basics" as to how [Company] functions/operates.
Follows existing procedures and processes.
Attends [Company] gatherings and social events.
Impresses upon others the important aspects of [Company].
Understands how decisions impact other business units beyond their immediate department of work group.
Global Perspective	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Excellent communication skills to conduct effective business with individuals from different cultures and/or countries.
Is able to work with individuals having different backgrounds and cultures.
Cooperates with others on a global scale.
Volunteers for experiences and assignments abroad.
Respects individual differences.
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.