Responsibility - 360 Degree Feedback Survey Sample #6

360-Degree Assessment Survey

Dear Employee:

You have been selected to participate in a 360-assessment. As part of this process you will need to complete the self-assessment questionnaire below.

In responding to the questions below, think about your experiences over the last 12 months. The effectiveness of this development tool is dependent on your honest, forthright and constructive responses so please bear this in mind as you answer each question. Your responses will be aggregated with the responses received from others. A report will be shared with you at the conclusion of this project.

We encourage everyone to complete the survey. Please be honest, constructive and thoughtful in your input. The survey is designed to help us understand more about your thoughts and needs to make this a great company.

The results of this survey will be used to help drive our future success. We will report back to you about what you have said and what we plan to do about it. If you have any questions about the process please contact [Contact Person].

Please ensure that your submission is made between . The survey will only be available during these dates.

Thank you for your participation in the survey. We look forward to seeing the analysis of your responses and we are hoping for 100% participation.

Management Team

Responsible	Needs Significant Improvement	Could benefit from Development	Capable and Effective	Role Model
You are responsible for setting the vision of the department.
You act as a resource without removing individual responsibility.
Your behavior is ethical and honest.
You work in a way that makes others want to work with you.
You hold yourself accountable to goals / objectives
Trustworthy	Needs Significant Improvement	Could benefit from Development	Capable and Effective	Role Model
You are trustworthy; is someone that can be trusted.
You consistently keep commitments.
You take care to maintain confidential information.
You seek to mitigate grievances by clarifying intentions and finding suitable remedies.
You demonstrate a sense of responsibility and commitment to public trust.
Establishing Focus/Direction	Needs Significant Improvement	Could benefit from Development	Capable and Effective	Role Model
You set appropriate goals for employees.
You make sure that employees understand how their work relates to organizational goals.
You align the department's goals with the goals of the organization.
You are excellent at managing time.
You maintain focus when handling several problems or tasks simultaneously.
Commitment To Result	Needs Significant Improvement	Could benefit from Development	Capable and Effective	Role Model
You coordinate all department activities into a cohesive team effort.
You take immediate action toward goals.
You create a sense of urgency among the store team members to complete activities, which drive sales.
You are willing to do whatever it takes-not afraid to have to put in extra effort.
You convey strong sense of own pride in Company to associates by creating a shared vision around sales and customer service.
Technical	Needs Significant Improvement	Could benefit from Development	Capable and Effective	Role Model
You are naturally sought out by people outside your particular area for advice and opinion on a broad range of matters - not necessarily solely legal advice.
You seek information from others as needed.
You demonstrate mastery of the technical competencies required in your work.
You keep current with technical advances within your professional discipline; embrace and apply new techniques and practices
You willingly share your technical expertise; sought out as resource by others
Negotiation	Needs Significant Improvement	Could benefit from Development	Capable and Effective	Role Model
You understand the expectations of other parties in the negotiation.
You are able to adapt to changing situations.
You are able to control your emotional responses and correctly gauge the emotions of others.
You conduct necessary preparations before engaging in negotiations.
You maintain communication channels between parties in the negotiation.
Continual Improvement	Needs Significant Improvement	Could benefit from Development	Capable and Effective	Role Model
You look for ways to expand and learn new job skills.
You are open to the suggestions from others.
You look for ways to expand current job responsibilities.
You look for ways to improve work processes and procedures.
You analyze processes to determine areas for improvement.
Strategic Focus	Needs Significant Improvement	Could benefit from Development	Capable and Effective	Role Model
You look for opportunities to enhance contributions to the bottom line.
You are able to decline a poor strategy by proposing alternate strategies.
You understand your role within the organization.
You understand and contribute to development of strategic goals.
You create plans to develop and promote organizational and area strengths, as well as to address weaknesses.
Planning	Needs Significant Improvement	Could benefit from Development	Capable and Effective	Role Model
I am able to efficiently manage deadlines.
I identify resource requirements that may impact the development of the 5-year plan.
I anticipate challenges and have plans to overcome them.
I can create a timeline for events and monitors progress.
I can accurately estimate the amount of materials/supplies needed for the project.

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

    5- Very Effective 4- Effective 3- Neither 2- Ineffective 1- Very Ineffective

    
    
47. Describe the greatest strengths of this person with regard to his/her overall effectiveness in performing his/her current responsibilities.
    
    
    
48. Describe the most important things this person could improve upon in order to increase his/her overall effectiveness in performing his/her current responsibilities.
    
    
    
49. Additional comments, if any for [Participant Name Here]'s assessment.