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 act as a resource without removing individual responsibility.
Your behavior is ethical and honest.
You take personal responsibility for results.
You complete assigned work tasks.
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 demonstrate a sense of responsibility and commitment to public trust.
You demonstrate congruence between statements and actions.
You take care to maintain confidential information.
You consistently keep commitments.
Establishing Focus/Direction	Needs Significant Improvement	Could benefit from Development	Capable and Effective	Role Model
You maintain self-control when personally criticized.
You stay focused even when under pressure and stress.
You are excellent at managing time.
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.
Commitment To Result	Needs Significant Improvement	Could benefit from Development	Capable and Effective	Role Model
You take immediate action toward goals.
You create a sense of urgency among the store team members to complete activities, which drive sales.
You maintain persistence and dedication to achieving results.
You are committed to the team.
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 willingly share your technical expertise; sought out as resource by others
You use expertise to identify issues and think through creative solutions to get a problem solved or objective accomplished.
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 keep current with technical advances within your professional discipline; embrace and apply new techniques and practices
You are knowledgeable of procedures or systems necessary for the job.
Negotiation	Needs Significant Improvement	Could benefit from Development	Capable and Effective	Role Model
You are able to clearly express thoughts and concerns.
You are able to decline bad ideas to avoid making poor decisions.
You conduct necessary preparations before engaging in negotiations.
You are able to influence others to accept certain positions.
You maintain good interpersonal relationships with representatives from the other party.
Continual Improvement	Needs Significant Improvement	Could benefit from Development	Capable and Effective	Role Model
You analyze processes to determine areas for improvement.
You promote training and development opportunities to enhance job performance.
You encourage an employee culture of continuous improvement to seek out better ways of doing things.
You look for ways to expand current job responsibilities.
You are open to the suggestions from others.
Strategic Focus	Needs Significant Improvement	Could benefit from Development	Capable and Effective	Role Model
I mobilize change through executive leadership to implement corporate strategies.
You assign individuals the responsibility of keeping track of progress toward achieving milestones.
I develop a strategic vision for the future.
I undertake a SWOT analysis to determine the best strategy to move forward.
You set strategic objectives to be achieved.
Planning	Needs Significant Improvement	Could benefit from Development	Capable and Effective	Role Model
I divide complex tasks into smaller steps to measure progress toward a goal.
I have plans to handle unexpected events.
I can create effective logistics plans to achieve high operational efficiency.
You have developed an effective strategic plan.
I develop plans used to accomplish urgent or critical tasks.

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.