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
Is a person you can trust.
Responsible for setting the vision of the department.
Holds herself / himself accountable to goals / objectives
Works in a way that makes others want to work with her/him.
...takes personal responsibility for results.
Adaptability	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Can take on new assignments.
Works effectively in dynamic and changing work environments.
Adjusts plans to meet new situations.
Develops insights and applies innovative solutions to projects and problems.
Continually trying to improve skills to remain current.
Self Management	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Analyzes interpersonal problems instead of reacting to them.
Consciously controls own negative emotions in order to keep team morale up.
Steps away from a situation to process appropriate response.
Sets an example for associates during stressful periods by maintaining a positive, can-do attitude.
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 able to manage their own emotions.
Is able to express themselves clearly.
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.
Able to understand others' points of view.
Management	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Sets an example for others to follow
Keep staff informed about what is happening in the company
Is ready to offer help
Makes you feel enthusiastic about your work
Takes responsibility for things that go wrong
Problem Solving	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Solves problems using logic and insight.
Implements effective solutions to critical problems.
Effective in solving problems.
Is a good problem solver and decision maker
Makes judgments based upon relevant information.
Strategic Focus	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Coordinates the implementation of the strategy with stakeholders.
Lets employees know how their roles contribute toward the achievement of strategic company objectives.
Ensures adherence to the strategy to sustain achievement of targeted levels of organizational performance.
Makes plans to handle unforeseen events that could impact the achievement of strategic goals.
Turns strategic priorities into action plans.
Fiscal Management	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Effective in using Company's resources.
Ensures others follow the correct rules and regulations on fiscal matters.
Develops of the department's annual budget.
Develops budgets and plans for various programs and initiatives.
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.