Responsibility- 360 Degree Feedback Survey Sample #1





360-Degree Feedback Survey

Questionnaires Measuring Responsibility:
Survey 1 (4-point scale; Competency Comments)
Survey 2 (4-point scale; Competency Comments)
Survey 3 (5-point scale; Competency Comments)
Survey 4 (5-point scale; radio buttons)
Survey 5 (4-point scale; words)
Survey 6 (4-point scale; words)
Survey 7 (5-point scale; competency comments; N/A)
Survey 8 (3-point scale; Agree/Disagree words; N/A)
Survey 9 (3-point scale; Strength/Development; N/A)
Survey 10 (Comment boxes only)
Survey 11 (Single rating per competency)
Survey 12 (Slide-bar scale)
Instructions:

[Company] is conducting a 360-Degree Feedback Assessment developed by HR-Survey for selected managers.

You have been selected to provide feedback on the employee listed above. Your feedback is an important part of our company's leadership development process and this survey is intended to gather broad feedback in the core competencies and role responsibilities that are important for the on-going success of our organization.

In responding to the questions below, think about your experiences working with this employee over the last twelve months. The effectiveness of this development tool is dependent on your honest, forthright and constructive responses so please bear this in mind as you answer each question. Your responses will be aggregated with the responses received from others and discussed with the employee to foster growth and on-going 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.

Competencies Included:
Responsible, Bias for Action, Feedback, Leadership, Performance, Communication Skills, Decision Making, Change Management, Business Acumen, Organizational Fluency
Sample Result Document:
Sample Results
Your feedback is valuable in helping the individual to understand how they are perceived and experienced by others and the impact their behavior has on people in the organization with whom they interact. Feedback received also acknowledges strengths and identifies areas for development.

Use the form below to provide your feedback. Each field and comment box requires a response before you can SUBMIT your final feedback.

Please ensure that your submission is made between . The survey will only be available during these dates.

Thank you for your participation in the survey. We look forward to seeing the analysis of your responses and we are hoping for 100% participation.

Management Team


Responsible

Needs
Improvement
Meets
Minimum
Standards
Is
Proficient
Role
Model
  1. Behavior is ethical and honest.
  1. Holds herself / himself accountable to goals / objectives
  1. Acts as a resource without removing individual responsibility.
  1. Responsible for setting the vision of the department.
  1. Sets a good example.
If [Participant Name] were to make improvements in Responsible, what are your suggestions for how he/she can improve this?

Bias for Action

Needs
Improvement
Meets
Minimum
Standards
Is
Proficient
Role
Model
  1. Projects a "can-do" attitude when interfacing with peers, subordinates and customers(especially during difficult and challenging times).
  1. Conveys a sense of urgency about addressing problems and opportunities
  1. Identifies ways to simplify work processes and reduce cycle times
  1. Completes work on time
  1. Seeks and utilizes opportunities for continuous learning and self-development.
If [Participant Name] were to make improvements in Bias for Action, what are your suggestions for how he/she can improve this?

Feedback

Needs
Improvement
Meets
Minimum
Standards
Is
Proficient
Role
Model
  1. Open to the suggestions of others.
  1. Looks to others for input.
  1. Accepts the views of others.
  1. Seeks feedback to enhance performance.
  1. Is easy to approach with ideas and opinions.
If [Participant Name] were to make improvements in Feedback, what are your suggestions for how he/she can improve this?

Leadership

Needs
Improvement
Meets
Minimum
Standards
Is
Proficient
Role
Model
  1. Able to influence others.
  1. Acts decisively in implementing decisions.
  1. Demonstrates leadership and courage in critical situations.
  1. Sets a high level of performance expectations and challenges others to do the same.
  1. Effectively leads others.
If [Participant Name] were to make improvements in Leadership, what are your suggestions for how he/she can improve this?

Performance

Needs
Improvement
Meets
Minimum
Standards
Is
Proficient
Role
Model
  1. Sets a high standard for job performance.
  1. Listens and responds to issues and problems
  1. Shown significant improvement in job performance.
  1. Works well in this position.
  1. ...Overall Performance
If [Participant Name] were to make improvements in Performance, what are your suggestions for how he/she can improve this?

Communication Skills

Needs
Improvement
Meets
Minimum
Standards
Is
Proficient
Role
Model
  1. Comes across as comfortable and effective as a public speaker
  1. Keeps open and regular communication with others.
  1. Communicates concepts and ideas to others.
  1. Keeps the supervisor informed about achievements and milestones.
  1. Reports progress on goals to the supervisor.
If [Participant Name] were to make improvements in Communication Skills, what are your suggestions for how he/she can improve this?

Decision Making

Needs
Improvement
Meets
Minimum
Standards
Is
Proficient
Role
Model
  1. Is able to learn from mistakes.
  1. Defines what constraints must be met for the decision making process.
  1. Facilitates meetings with others to try to consider alternative courses of action.
  1. Determines constraints that may impact what decisions are acceptable.
  1. Learns from previous bad decisions and rarely repeats them.
If [Participant Name] were to make improvements in Decision Making, what are your suggestions for how he/she can improve this?

Change Management

Needs
Improvement
Meets
Minimum
Standards
Is
Proficient
Role
Model
  1. Effective in dealing with ambiguous and challenging situations.
  1. Adopts changes to set and example for others to follow.
  1. Is a leading force driving changes.
  1. Facilitates change with minimal resistance.
  1. Addresses organizational and departmental resistance to changes.
If [Participant Name] were to make improvements in Change Management, what are your suggestions for how he/she can improve this?

Business Acumen

Needs
Improvement
Meets
Minimum
Standards
Is
Proficient
Role
Model
  1. Exhibits behavior that is consistent with the vision, mission, and core values of the organization
  1. Understands the dynamics of our industry.
  1. Considers environmental, social, and governance (ESG) factors to ensure the business is sustainable in the long run.
  1. Considers impact of actions on other areas of the organization.
  1. Can effectively interpret and analyze data.
If [Participant Name] were to make improvements in Business Acumen, what are your suggestions for how he/she can improve this?

Organizational Fluency

Needs
Improvement
Meets
Minimum
Standards
Is
Proficient
Role
Model
  1. Able to use corporate politics to advance department objectives.
  1. Is aware of other organizational cultures to compare/contrast with the current organizational culture.
  1. Anticipates problems that may affect the department.
  1. Understands departmental policies and procedures.
  1. Understands the current organizational culture.
If [Participant Name] were to make improvements in Organizational Fluency, what are your suggestions for how he/she can improve this?

  1. What are [Participant Name Here]'s greatest strengths demonstrated this year?


  2. What are [Participant Name Here]'s areas for development?


  3. Please give any final comments or suggestions for [Participant Name Here]'s assessment.