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 set a good example
You are responsible for setting the vision of the department.
You complete assigned work tasks.
You act as a resource without removing individual responsibility.
You hold yourself accountable to goals / objectives
Trustworthy	Needs Significant Improvement	Could benefit from Development	Capable and Effective	Role Model
You take care to maintain confidential information.
You demonstrate congruence between statements and actions.
You build and maintain the trust of others.
You consistently keep commitments.
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 maintain focus when handling several problems or tasks simultaneously.
You align the department's goals with the goals of the organization.
You maintain self-control when personally criticized.
You make sure that employees understand and identify with the team's mission.
You help guide employees with prioritizing tasks.
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 maintain persistence and dedication to achieving results.
You are able to focus on a task even when working alone.
You create a sense of urgency among the store team members to complete activities, which drive sales.
Technical	Needs Significant Improvement	Could benefit from Development	Capable and Effective	Role Model
You use expertise to identify issues and think through creative solutions to get a problem solved or objective accomplished.
You keep current with technical advances within your professional discipline; embrace and apply new techniques and practices
You seek information from others as needed.
You know how to produce high quality products/work.
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 stay calm and focus on the core issues to be discussed.
I establish a strong, cooperative atmosphere; defines expectations; and presents a well-structured agenda aligned with key priorities.
You thoroughly understand the interests and possibilities of both sides.
You identify goals and objectives desired as well as the strengths and weaknesses currently possessed.
I develop a unified understanding or strategy that acknowledges and addresses the different viewpoints and resolves conflicts.
Continual Improvement	Needs Significant Improvement	Could benefit from Development	Capable and Effective	Role Model
You look for ways to improve work processes and procedures.
You look for ways to expand current job responsibilities.
You look for ways to expand and learn new job skills.
You analyze processes to determine areas for improvement.
You are open to the suggestions from others.
Strategic Focus	Needs Significant Improvement	Could benefit from Development	Capable and Effective	Role Model
You strategically position resources to meet the needs of field based employees.
I inspire employees to adopt the strategic plan.
You scan the environment for opportunities to exploit.
I can successfully implement a strategic plan.
You identify areas where return on investment can be improved.
Planning	Needs Significant Improvement	Could benefit from Development	Capable and Effective	Role Model
I identify resource requirements that may impact the development of the 5-year plan.
I anticipate the impacts of strategic plans.
You create to-do lists to make sure nothing is missed.
I assess the risks of various strategic plans.
I always have a "Plan-B" ready if needed.

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.