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.

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 by .

Thank you for your participation in the survey.

Management Team

Responsible	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Behavior is ethical and honest.
Holds herself / himself accountable to goals / objectives
Sets high personal standards of performance.
Completes assigned work tasks.
Works in a way that makes others want to work with her/him.
Adaptability	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Is proactive and takes steps to prepare for changes in the workplace.
Works effectively in dynamic and changing work environments.
Performs a wide range of tasks, responds to changes in direction and priorities and accepts new challenges, responsibilities, and assignments.
Adjusts priorities to changing business goals.
Ability to recognize the potential benefits of change, and create an infrastructure which supports change.
Self Management	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Steps away from a situation to process appropriate response.
Uses patience and self-control in working with customers and associates.
Consciously controls own negative emotions in order to keep team morale up.
Analyzes interpersonal problems instead of reacting to them.
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
Is attentive to emotional cues and interprets others' feelings correctly.
Helps to make decisions and solve problems using knowledge about how others will react in certain situations.
Is able to manage their own emotions.
Helps employees to resolve conflicts, communicate clearly, and work together to solve problems.
Is able to express themselves clearly.
Management	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Makes you feel enthusiastic about your work
Sets an example for others to follow
Is ready to offer help
Delegate tasks effectively
Takes responsibility for things that go wrong
Problem Solving	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Generates alternative solutions to problems and challenges.
Ability to solve problems at root cause rather than at symptom level.
Effective in solving problems.
Finds creative ways to get things done with limited resources.
Makes judgments based upon relevant information.
Strategic Focus	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Able to decline a poor strategy by proposing alternate strategies.
Understands & contributes to development of strategic goals.
Creates plans to develop and promote organizational and area strengths, as well as to address weaknesses.
Understands their role within the organization.
Sustains or achieves a competitive advantage for the organization by analyzing the best practices and lessons learned from other organizations.
Fiscal Management	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Provides budgeting and accounting support to the Company.
Develops budgets and plans for various programs and initiatives.
Effectively manages appropriations, reporting, purchases, expenditures, payrolls, and staff.
Monitors spending.
Develops of the department's annual budget.

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.