Responsibility - 360 Degree Feedback Survey Sample #5

360-Degree Assessment Survey

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
Is a person you can trust.
Sets a good example
...takes personal responsibility for results.
Completes assigned work tasks.
Acts as a resource without removing individual responsibility.
Adaptability	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Adjusts to new plans and procedures.
Is aware of changes to the policies and procedures.
Adjusts tactics and strategies.
Is aware of changes in the environment.
Able to respond to incidents without stopping the workflow.
Self Management	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Analyzes interpersonal problems instead of reacting to them.
Deals with conflict by controlling own emotions by listening, being flexible, and sincere in responding.
Sets an example for associates during stressful periods by maintaining a positive, can-do attitude.
Consciously controls own negative emotions in order to keep team morale up.
Is aware of personal impact on others and adjusts behavior to create a positive leadership presence.
Emotional Intelligence	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Helps employees to resolve conflicts, communicate clearly, and work together to solve problems.
Is able to control their own emotions.
Accurately perceives the emotional reactions of others.
Helps to make decisions and solve problems using knowledge about how others will react in certain situations.
Is able to express themselves clearly.
Management	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Keep staff informed about what is happening in the company
Sets an example for others to follow
Takes responsibility for things that go wrong
Makes you feel enthusiastic about your work
Delegate tasks effectively
Problem Solving	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Understands the root causes of problems.
Identifies and assesses all potential responses to a problem.
Ability to solve problems at root cause rather than at symptom level.
Solves problems using logic and insight.
Identifies fresh approaches and shows a willingness to question traditional assumptions.
Strategic Focus	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Identifies business strategies to strengthen competitive capabilities.
Creates values statement to ensure all employees are working under the same guiding principles.
Strategically positions resources to meet the needs of branch locations.
Makes decisions that yield more competitive advantages.
Creates measures of performance and profitability to assess financial objectives.
Fiscal Management	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Effective in using Company's resources.
Provides budgeting and accounting support to the Company.
Develops of the department's annual budget.
Ensures others follow the correct rules and regulations on fiscal matters.
Develops budgets and plans for various programs and initiatives.

41. Overall, please rate the effectiveness of [Participant Name Here].
    

    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 [Participant Name Here]'s assessment.