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

• Sets a good example
• Acts as a resource without removing individual responsibility.
• Sets a good example.
• Holds herself / himself accountable to goals / objectives
• Completes assigned work tasks.

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

Action

• Establishes the tasks and direction for the team.
• Takes action to respond to dissatisfied customer.
• Is not afraid to take corrective action when necessary.
• Takes the initiative and does not wait for the situation to change.
• Decides to act rather than remain passive.

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

Goals

• Makes sure that I have a clear idea of our group's goals.
• Conducts timely follow-up; keeps others informed on a need to know basis.
• Achieves goals.
• Establishes and documents goals and objectives.
• Goal Setting

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.
• Creates opportunities for professional development.
• Develops employees by offering and encouraging them to take on new or additional responsibilities.
• Sets performance objectives for subordinates that encourages development opportunities.
• Is open to receiving feedback.

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

Strategic Insight

• Analyzes records and reports to obtain insight into potential issues and trends.
• Creates a mission statement describing the purpose for the organization.
• Anticipates business cycles and trends and makes adjustments in a timely manner.
• Converses with customers and clients to get a better insight into their personal needs.
• Maintains knowledge of current trends in the industry.

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.