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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)
Survey 13 (4-point scale; numbers; floating anchors)
Survey 14 (4-point scale; N/A)
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
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Responsible

Needs
Improvement
Meets
Minimum
Standards
Is
Proficient
Role
Model
  1. Responsible for setting the vision of the department.
  1. Sets high personal standards of performance.
  1. Behavior is ethical and honest.
  1. Acts as a resource without removing individual responsibility.
  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. Identifies ways to simplify work processes and reduce cycle times
  1. Projects a "can-do" attitude when interfacing with peers, subordinates and customers(especially during difficult and challenging times).
  1. Seeks and utilizes opportunities for continuous learning and self-development.
  1. Completes a large volume of work.
  1. Motivates others to achieve or exceed goals
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. Actively seeks feedback from others.
  1. Is visible and approachable.
  1. Accepts the views of others.
  1. Considers other's opinion and suggestions.
  1. Asks others for their 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. Sets specific, measurable, and challenging goals.
  1. Acts decisively in implementing decisions.
  1. Able to influence others.
  1. Demonstrates leadership and courage in critical situations.
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. Works effectively in the department.
  1. ...Overall Performance
  1. Has great overall performance
  1. Listens and responds to issues and problems
  1. Works well in this position.
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. Effectively engages with everyone from the CEO to external partners.
  1. Communicates effectively with colleagues and customers
  1. Articulates ideas and emotions clearly to others.
  1. Communicates with department leadership
  1. Responds to questions with accurate and complete answers
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. Performs a cost/benefit analysis before making a decision.
  1. Coaches team members individually when "poor" decisions are made; helps them see what could have been done differently
  1. Makes decisions independently (without having to be told what or how).
  1. Understands how different perspectives can help make better informed decisions.
  1. Is aware of the impact of decisions and informs others about potential outcomes.
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. Inspires others to accept changes.
  1. Works cooperatively with others to implement changes.
  1. Adopts changes to set and example for others to follow.
  1. Addresses organizational and departmental resistance to changes.
  1. Able to get team members to change their attitudes.
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. Considers impact of actions on other areas of the organization.
  1. Maintains currency with laws, regulations, policies, procedures, trends, and developments.
  1. Applies the knowledge of work processes to influence the achievement of business goals
  1. Interprets data to make informed business decisions.
  1. Provides a high level of business services to customers.
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 deal with sensitive issues with tact and professionalism.
  1. Able to explain departmental policies and procedures to others.
  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. Adept at navigating within the culture of the department.
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.