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.
• Acts as a resource without removing individual responsibility.
• Is a person you can trust.
• 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

• Motivates & supports others to gain skills
• Gets the job done.
• Makes effective decisions, even when under pressure.
• Displays high energy and enthusiasm on consistent basis.
• Effectively makes decisions

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

Goals

• Makes sure that team members have a clear idea of our group's goals.
• Goal Setting
• Achieves goals.
• Sets high expectations and goals; encourages others to support the organization.
• Achieves established goals.

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

Developing Others

• Develops employees by offering and encouraging them to take on new or additional responsibilities.
• Assesses employees' developmental needs.
• Is open to receiving feedback.
• Assigns tasks and responsibilities to develop skills of others.
• Recognizes and celebrates accomplishments of others.

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

Strategic Insight

• Maintains knowledge of current trends in the industry.
• Identifies potential problems before they become critical incidents.
• Formulates strategies and action plans to ensure successful completion of goals and objectives.
• Implements long-term solutions to problems.
• Formulates policies and strategies for addressing the Company's important challenges.

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.