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. Sets high personal standards of performance.
  1. Sets a good example.
  1. Responsible for setting the vision of the department.
  1. Works in a way that makes others want to work with her/him.
  1. Completes assigned work tasks.
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. Completes a large volume of work.
  1. Projects a "can-do" attitude when interfacing with peers, subordinates and customers(especially during difficult and challenging times).
  1. Displays high energy and enthusiasm on consistent basis.
  1. Motivates others to achieve or exceed goals
  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. Is visible and approachable.
  1. Shares past experiences with others as learning opportunities.
  1. Accepts the views of others.
  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. Takes ownership and accountability for results
  1. Able to influence others.
  1. Demonstrates leadership and courage in critical situations.
  1. Sets specific, measurable, and challenging goals.
  1. Provides resources to enable individuals to develop professionally.
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. Listens and responds to issues and problems
  1. ...Overall Performance
  1. Effectively organizes resources and plans
  1. Effective in performing his/her job.
  1. Sets a high standard for job 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. Engages in clear communication with both senior and junior management.
  1. Open to receiving feedback from others.
  1. Uses software, graphics, or other aids to clarify complex or technical reports.
  1. Checks for understanding throughout conversations or group presentations/discussions
  1. Prepares and delivers presentations.
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. Open to the suggestions from subordinates.
  1. Examines relevant factors needed to make a decision.
  1. Has enough self-control to avoid making impulsive decisions.
  1. Views the issues from multiple perspectives before making a decision.
  1. Identifies parameters impacting the decision.
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. Assists others in understanding changes to the organization.
  1. Effective in dealing with ambiguous and challenging situations.
  1. Effective in implementing new organizational vision and values.
  1. Inspires others to accept changes.
  1. Develops a strategy for implementing 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. Keeps informed of current income and expenses.
  1. Develops business plans that are forward looking.
  1. Gathers essential customer data to align our products with their expectations.
  1. Collects valuable customer insights to ensure our services meet their needs.
  1. Gathers important information from customers to make sure our products are relevant and useful.
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. Effective in communicating with others within the organization.
  1. Understands departmental policies and procedures.
  1. Is aware of other organizational cultures to compare/contrast with the current organizational culture.
  1. Able to explain departmental policies and procedures to others.
  1. Able to use corporate politics to advance department objectives.
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.