Responsibility - 360 Degree Feedback Survey Sample #5

Dear Employee:

Thank you for providing feedback for the recipient above. As you respond, please draw on your first-hand experience with this individual in the past 12 months. Rate each item using the scale shown. If you don't feel you have enough first-hand information to rate a certain item, please choose the Not Applicable option. Comments can be very helpful; at a minimum where you give a particularly high or low rating, please share your reasons in the Closing Comments section. Your responses will be compiled with feedback from others and presented to the recipient to help guide their ongoing development.

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Please ensure that your submission is made by .

Thank you for your participation in the survey.

Management Team

Responsible	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Acts as a resource without removing individual responsibility.
Works in a way that makes others want to work with her/him.
...takes personal responsibility for results.
Sets high personal standards of performance.
Is a person you can trust.
Adaptability	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Is flexible and open minded in dealing with others.
Performs a wide range of tasks, responds to changes in direction and priorities and accepts new challenges, responsibilities, and assignments.
Able to quickly learn new ways of performing their job.
Learns from personal experiences and/or mistakes.
Is proactive and takes steps to prepare for changes in the workplace.
Self Management	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Analyzes interpersonal problems instead of reacting to them.
Is aware of personal impact on others and adjusts behavior to create a positive leadership presence.
Uses patience and self-control in working with customers and associates.
Does not allow own emotions to interfere with the performance of others.
Deals with conflict by controlling own emotions by listening, being flexible, and sincere in responding.
Emotional Intelligence	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Able to understand others' points of view.
Is able to express themselves clearly.
Helps employees to resolve conflicts, communicate clearly, and work together to solve problems.
Accurately perceives the emotional reactions of others.
Helps to make decisions and solve problems using knowledge about how others will react in certain situations.
Management	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Is ready to offer help
Takes responsibility for things that go wrong
Sets an example for others to follow
Keep staff informed about what is happening in the company
Delegate tasks effectively
Problem Solving	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Able to balance the needs of different people in a solution to a problem.
Works cooperatively with others to solve problems.
Is a good problem solver and decision maker
Ability to solve problems at root cause rather than at symptom level.
Ability to develop innovative solutions to problems.
Strategic Focus	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Understands their role within the organization.
Focuses attention on treating the causes of problems rather than simply addressing the symptoms.
Monitors performance of each market within the Area, utilizing reports to ensure sales growth, cost management, and profitability targets are met.
Understands & contributes to development of strategic goals.
Communicates goals and objectives to employees.
Fiscal Management	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Provides budgeting and accounting support to the Company.
Monitors spending.
Keeps excellent records for financial transparency.
Effective in using Company's resources.
Effectively manages appropriations, reporting, purchases, expenditures, payrolls, and staff.

41. Overall, please rate the effectiveness of .
    

    5- Very Effective 4- Effective 3- Neither 2- Ineffective 1- Very Ineffective

    
    
42. Strengths
    
    
    
43. Areas for Development
    
    
    
44. Please give any final comments or suggestions for 's assessment.