Responsibility - 360 Degree Feedback Survey Sample #2





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

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 and the goals they were asked to achieve. 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 discussed with the employee to foster growth and on-going development.

Competencies Included:
Responsible, Emotional Intelligence, Management, Supervisory Skills, Professional Development, Persuasion and Influence, Objectives, Client Focus, Co-worker Development, Entrepreneurship, Company
Sample Result Document:
Sample Results
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 between . The survey will only be available during these dates.


Responsible

Clear
Strength
Capable
and
Effective
Could
Benefit from
Development
Needs
Significant
Improvement
  1. Responsible for setting the vision of the department.
  1. Behavior is ethical and honest.
  1. Completes assigned work tasks.
  1. ...takes personal responsibility for results.
  1. Holds herself / himself accountable to goals / objectives
What are your suggestions for how [Participant Name] can make improvements
in Responsible?

Emotional Intelligence

Clear
Strength
Capable
and
Effective
Could
Benefit from
Development
Needs
Significant
Improvement
  1. Able to understand others' points of view.
  1. Accurately perceives the emotional reactions of others.
  1. Is attentive to emotional cues and interprets others' feelings correctly.
  1. Is able to express themselves clearly.
  1. Helps employees to resolve conflicts, communicate clearly, and work together to solve problems.
What are your suggestions for how [Participant Name] can make improvements
in Emotional Intelligence?

Management

Clear
Strength
Capable
and
Effective
Could
Benefit from
Development
Needs
Significant
Improvement
  1. Keep staff informed about what is happening in the company
  1. Is ready to offer help
  1. Sets an example for others to follow
  1. Takes responsibility for things that go wrong
  1. Delegate tasks effectively
What are your suggestions for how [Participant Name] can make improvements
in Management?

Supervisory Skills

Clear
Strength
Capable
and
Effective
Could
Benefit from
Development
Needs
Significant
Improvement
  1. Encourages employees to achieve their full potential.
  1. Has a high degree of multi-cultural competence to supervise individuals of various cultural backgrounds.
  1. Is respectful toward employees.
  1. Facilitates team members working well together.
  1. Reviews performance against established measures.
What are your suggestions for how [Participant Name] can make improvements
in Supervisory Skills?

Professional Development

Clear
Strength
Capable
and
Effective
Could
Benefit from
Development
Needs
Significant
Improvement
  1. Seeks opportunities for professional development.
  1. Contributing fully to the extent of their skills
  1. Seeks opportunities for continuous learning.
  1. Encourages employees to take courses relevant to their job.
  1. Demonstrate enthusiasm and a willingness to learn new skills and knowledge
What are your suggestions for how [Participant Name] can make improvements
in Professional Development?

Persuasion and Influence

Clear
Strength
Capable
and
Effective
Could
Benefit from
Development
Needs
Significant
Improvement
  1. Ensures stakeholders are involved in the decision making process.
  1. Able to express own goals and needs.
  1. Develops a good rapport with others.
  1. Persuades others to consider alternative points of view.
  1. Attempts to persuade others rather than simply control them.
What are your suggestions for how [Participant Name] can make improvements
in Persuasion and Influence?

Objectives

Clear
Strength
Capable
and
Effective
Could
Benefit from
Development
Needs
Significant
Improvement
  1. Assures [Company] principles are understood, employed & pursued.
  1. Encourages me to take on greater responsibility.
  1. Works toward achieving established goals and objectives.
  1. Organizes and schedules events, activities, and resources.
  1. Able to organize work.
What are your suggestions for how [Participant Name] can make improvements
in Objectives?

Client Focus

Clear
Strength
Capable
and
Effective
Could
Benefit from
Development
Needs
Significant
Improvement
  1. Takes the initiative in solving difficult client issues.
  1. Responsive to client needs.
  1. Acts with integrity in all client interactions.
  1. Exhibits a positive attitude even when dealing with difficult clients.
  1. Meets with clients on a regular basis.
What are your suggestions for how [Participant Name] can make improvements
in Client Focus?

Co-worker Development

Clear
Strength
Capable
and
Effective
Could
Benefit from
Development
Needs
Significant
Improvement
  1. Adapts coaching and mentoring approach to meet the style or needs of individuals
  1. Provides ongoing feedback to co-workers on their development progress
  1. Sets and clearly communicates expectations, performance goals, and measurements to others
  1. Works to identify root causes of performance problems
  1. Gives others development opportunities through project assignments and increased job responsibilities
What are your suggestions for how [Participant Name] can make improvements
in Co-worker Development?

Entrepreneurship

Clear
Strength
Capable
and
Effective
Could
Benefit from
Development
Needs
Significant
Improvement
  1. Seeks and utilizes mentors to help guide professional development.
  1. Encourages risk taking for developing potential business opportunities.
  1. Can work effectively in an environment of uncertainty.
  1. Encourages dynamic growth opportunities.
  1. Exhibits determination and passion in completion of goals.
What are your suggestions for how [Participant Name] can make improvements
in Entrepreneurship?

Company

Clear
Strength
Capable
and
Effective
Could
Benefit from
Development
Needs
Significant
Improvement
  1. Understands the use of [Company] products and services.
  1. Understands how decisions impact other business units beyond their immediate department of work group.
  1. Follows existing procedures and processes.
  1. Attends [Company] gatherings and social events.
  1. Impresses upon others the important aspects of [Company].
What are your suggestions for how [Participant Name] can make improvements
in Company?


  1. Strengths


  2. Areas for Development


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