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.
Your behavior is ethical and honest.
You hold yourself accountable to goals / objectives
You act as a resource without removing individual responsibility.
You take personal responsibility for results.
Trustworthy	Needs Significant Improvement	Could benefit from Development	Capable and Effective	Role Model
You communicate an understanding of the other person's interests, needs and concerns.
You demonstrate congruence between statements and actions.
You consistently keep commitments.
You work in a way that makes others want to work with you.
You take ownership, deliver on commitments
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 function well under stress, deadlines, and/or significant workloads.
You help guide employees with prioritizing tasks.
You make sure that employees understand and identify with the team's mission.
You maintain self-control when personally criticized.
Commitment To Result	Needs Significant Improvement	Could benefit from Development	Capable and Effective	Role Model
You encourage commitment in others to obtain results.
You are able to focus on a task even when working alone.
You coordinate all department activities into a cohesive team effort.
You are willing to do whatever it takes-not afraid to have to put in extra effort.
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 keep current with technical advances within your professional discipline; embrace and apply new techniques and practices
You demonstrate mastery of the technical competencies required in your work.
You use expertise to identify issues and think through creative solutions to get a problem solved or objective accomplished.
You seek information from others as needed.
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.
Negotiation	Needs Significant Improvement	Could benefit from Development	Capable and Effective	Role Model
I keep a firm grasp on the issues and priorities.
I am resolute on positions to provide consistency in the negotiation strategy.
I use the motivations of each party to identify mutually advantageous solutions.
You are prepared to walk away if core interests are not met.
You actively listen to conversations to be able to recall important details later.
Continual Improvement	Needs Significant Improvement	Could benefit from Development	Capable and Effective	Role Model
You are open to the suggestions from others.
You encourage an employee culture of continuous improvement to seek out better ways of doing things.
You search for new methods, techniques, and processes that increase efficiency and reduce costs.
You look for ways to improve work processes and procedures.
You look for ways to expand and learn new job skills.
Strategic Focus	Needs Significant Improvement	Could benefit from Development	Capable and Effective	Role Model
I make strategic decisions to optimize the returns on capital investments.
Yoy scan both the internal and external environment to identify strategic opportunities to improve the organization.
I develop strategies that are practical and can be feasibly implemented within a reasonable period of time.
You align projects to the strategic goals of the company.
I give adequate consideration to the time and resources available.
Planning	Needs Significant Improvement	Could benefit from Development	Capable and Effective	Role Model
I ensure staff have the supplies and resources necessary to enact the plan.
I schedule staff based on seasonal needs.
You determine what supplies/equipment will be needed for the department.
You anticipate resources needed to successfully implement a plan or project.
You determine what supplies/equipment will be 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.