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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. Works in a way that makes others want to work with her/him.
  1. Is a person you can trust.
  1. Behavior is ethical and honest.
  1. Completes assigned work tasks.
  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 that, within the department, is contagious.
  1. Keeps the team regularly updated as to the progress to ensure everyone is aware of what work still needs to be done.
  1. Establishes clear and actionable goals to guide the team's efforts and ensure progress.
  1. Eagerly volunteers for projects.
  1. Thinks outside the box to find innovative solutions to problems.
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 out constructive criticism and praise from colleagues, supervisors, and team members.
  1. Seeks a more comprehensive understanding of abilities and identifies specific areas for improvement.
  1. Vigorously seeks out and applies feedback from multiple channels.
  1. Integrates feedback appropriately to support professional advancement, ensuring it is handled with integrity.
  1. Enables employees to improve performance by providing feedback.
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. Has own self-development plan; seeks opportunities for self-development on an ongoing basis
  1. Maximizes the efforts of all team members.
  1. Selects the best and brightest people from inside or outside the company.
  1. Recognizes and appreciates the work of others.
  1. Accepts responsibility for organizational performance.
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. Effectively organizes resources and plans
  1. Able to organize work.
  1. Has great overall performance
  1. ...Overall Performance
  1. Effective in performing his/her job.
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. Listens to others' points of view with an open mind
  1. Is willing to give feedback to others even if that feedback is critical of their approach.
  1. Informs supervisor about progress made on goals and objectives.
  1. Accurately attends to/understands ideas which are exchanged.
  1. Conducts impactful training sessions.
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. Integrates environmental factors that may restrict or shape decision outcomes.
  1. Connects unrelated concepts or data points to form innovative solutions that others may overlook.
  1. Has enough self-control to avoid making impulsive decisions.
  1. Decides which short- and long-term goals should be created.
  1. Gathers information before making a 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. Inspires others to adopt the necessary changes.
  1. Assists others in understanding changes to the organization.
  1. Develops strategic plans to mitigate the negative effects of imminent changes.
  1. Ensures that employees and teams comply with the recent changes.
  1. Generates commitment to the changes through a compelling vision for the future.
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. Understands business fundamentals and practices.
  1. Asks the 'right' questions to size up or evaluate situations.
  1. Possesses a clear grasp of the company's financial indicators.
  1. Anticipates the consequences to the business of different potential risk events.
  1. Understands and applies business and financial principles.
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. Adept at navigating within the culture of the department.
  1. Able to use corporate politics to advance department objectives.
  1. Understands the current organizational culture.
  1. Is aware of other organizational cultures to compare/contrast with the current organizational culture.
  1. Effective in communicating with others within the organization.
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.