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
...takes personal responsibility for results.
Behavior is ethical and honest.
Works in a way that makes others want to work with her/him.
Is a person you can trust.
Sets a good example
Adaptability	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Responsive to the needs of others.
Able to adjust to changes as needed.
Is open to changes in policies and procedures.
Able to quickly learn new ways of performing their job.
Able to adjust to changing environments.
Self Management	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Deals with conflict by controlling own emotions by listening, being flexible, and sincere in responding.
Steps away from a situation to process appropriate response.
Does not allow own emotions to interfere with the performance of others.
Analyzes interpersonal problems instead of reacting to them.
Sets an example for associates during stressful periods by maintaining a positive, can-do attitude.
Emotional Intelligence	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Helps to make decisions and solve problems using knowledge about how others will react in certain situations.
Helps employees to resolve conflicts, communicate clearly, and work together to solve problems.
Is able to control their own emotions.
Is able to express themselves clearly.
Able to understand others' points of view.
Management	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Delegate tasks effectively
Keep staff informed about what is happening in the company
Is ready to offer help
Takes responsibility for things that go wrong
Makes you feel enthusiastic about your work
Problem Solving	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Understands the root causes of problems.
Works cooperatively with others to solve problems.
Implements effective solutions to critical problems.
Makes judgments based upon relevant information.
Generates alternative solutions to problems and challenges.
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.
Looks for opportunities to enhance contributions to the bottom line.
Focuses attention on treating the causes of problems rather than simply addressing the symptoms.
Fiscal Management	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Develops budgets and plans for various programs and initiatives.
Develops of the department's annual budget.
Provides budgeting and accounting support to the Company.
Effectively manages appropriations, reporting, purchases, expenditures, payrolls, and staff.
Monitors expenses and verifies the need for items purchased.

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.