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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Thank you for your participation in the survey.

Management Team

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Responsible	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Behavior is ethical and honest.
Works in a way that makes others want to work with her/him.
Completes assigned work tasks.
Holds herself / himself accountable to goals / objectives
...takes personal responsibility for results.
Adaptability	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Adjusts tactics and strategies.
Willing to see things from others' perspectives.
Flexible and adaptable when confronted with unexpected changes.
Learns new skills to become competitive and contribute to the bottom line.
Able to meet the needs of various stakeholders.
Self Management	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Is aware of personal impact on others and adjusts behavior to create a positive leadership presence.
Steps away from a situation to process appropriate response.
Uses patience and self-control in working with customers and associates.
Deals with conflict by controlling own emotions by listening, being flexible, and sincere in responding.
Consciously controls own negative emotions in order to keep team morale up.
Emotional Intelligence	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Is attentive to emotional cues and interprets others' feelings correctly.
Helps employees to resolve conflicts, communicate clearly, and work together to solve problems.
Able to understand others' points of view.
Is able to manage their own emotions.
Is able to express themselves clearly.
Management	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Leads the team through visible, disciplined execution that motivates others to maximize their own contributions.
Maintains an open-door policy to be available to answer questions and provide guidance to employees.
Monitors performance metrics and takes ownership for meeting targets.
Assigns tasks based on employee strengths and development goals, ensuring clarity and ownership.
Transforms personal discipline into collective action, inspiring others to rise to the occasion.
Problem Solving	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Implements solutions to solve the problem.
Evaluates alternative courses of action.
Uses charting tools to identify patterns in data.
Creates an environment where team members feel free to share their thoughts and ideas without fear of criticism.
Asks the right questions to size up or evaluate situations.
Strategic Focus	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Develops a corporate strategy to establish business operations in different locations.
Crafts and executes strategies to advance the company.
Pursues strategic alliances with valued partners.
Creates a mission statement describing the purpose for the organization.
Identifies ways in which the company is better able to meet the customers' needs than rivals.
Fiscal Management	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Develops of the department's annual budget.
Effectively manages appropriations, reporting, purchases, expenditures, payrolls, and staff.
Develops budgets and plans for various programs and initiatives.
Monitors expenses and verifies the need for items purchased.
Monitors spending.

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.