Responsibility - 360 Degree Feedback Survey Sample #10

360 Feedback Survey

Instructions

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 comment section for that competency. 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.

Responsible

• Works in a way that makes others want to work with her/him.
• Holds herself / himself accountable to goals / objectives
• Sets a good example.
• Is a person you can trust.
• Responsible for setting the vision of the department.

If [Participant Name] were to make improvements in Responsible, what are your suggestions for how he/she can improve this?

Action

• Anticipates needs and takes pre-emptive action to address the issue.
• Works quickly to get the job done.
• Works across organizational lines and boundaries to attain goals.
• Prepares equipment at the start of the shift.
• Takes action to respond to dissatisfied customer.

If [Participant Name] were to make improvements in Action, what are your suggestions for how he/she can improve this?

Goals

• Sets high expectations and goals; encourages others to support the organization.
• Makes sure that team members have a clear idea of our group's goals.
• Conducts timely follow-up; keeps others informed on a need to know basis.
• Establishes and documents goals and objectives.
• Achieves goals.

If [Participant Name] were to make improvements in Goals, what are your suggestions for how he/she can improve this?

Developing Others

• Provides constructive feedback to others.
• Supports the successes of other employees.
• Assesses employees' developmental needs.
• Tries to ensure employees are ready to move to the next level.
• Creates a work environment that fosters positive feedback to employees.

If [Participant Name] were to make improvements in Developing Others, what are your suggestions for how he/she can improve this?

Strategic Insight

• Creates a vision for the organization based on insights gathered from other companies in the industry.
• Lets employees know how their roles contribute toward the achievement of strategic company objectives.
• Meets with customers to gain insight into their core needs and how best to serve them.
• Formulates policies and strategies for addressing the Company's important challenges.
• Analyzes unique issues or problems impacting the Company.

If [Participant Name] were to make improvements in Strategic Insight, what are your suggestions for how he/she can improve this?

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

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

Strengths


Areas for Development


Please give any final comments or suggestions for [Participant Name Here]'s assessment.