Responsibility - 360 Degree Feedback Survey Sample #11

360 Feedback Survey

Instructions

We appreciate you taking the time to provide valuable feedback for the individual mentioned above. As you respond, please draw on your first-hand experience with this individual in the past 12 months. Your insights are crucial in offering a comprehensive evaluation. Please rate each item using the scale provided. If you find that you do not have sufficient first-hand knowledge to rate a particular item, select the Not Applicable option.

In addition to the ratings, we encourage you to include comments where possible. These comments are particularly useful when you give a very high or very low rating, as they provide context and clarity regarding your assessment. Explaining your reasons in the comment section helps ensure that your feedback is constructive and actionable.

Your responses, combined with feedback from other contributors, will be compiled and presented to the individual. This collective feedback aims to support their continuous growth and development by highlighting strengths and identifying areas for improvement. Your thoughtful participation is essential in helping them achieve their full potential.

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.

To what extent does [Participant Name] exhibit the following ...

SELECT the rating that best reflects the employee's performance in the areas listed.

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Responsible

What does Responsible mean?
It means that ...

• You are a person others can trust.
• You set a good example.
• You are responsible for setting the vision of the department.
• You hold yourself accountable to goals / objectives
• You act as a resource without removing individual responsibility.

To what extent does this person exhibit Responsible?
Select from one of the ratings below.

Not Applicable or Unable to Judge

Poor does not perform to expected standards; often unable to complete tasks; does not seek help or advice

Minimal completes tasks only when pressured to do so; is satisfied with minimal progress; only does what is required

Average completes tasks easily; seeks to obtain maximal performance; willing to seek advice and help when needed

Role Model is a role model for others to follow; goes above and beyond what is expected; helps others

Excellence

What does Excellence mean?
It means that ...

• You demonstrate the analytical skills to do your job.
• You are planful and organized.
• You demonstrate the functional or technical skills necessary to do your job.
• You take a lot of pride in your work.
• You can be counted on to add value wherever you are involved.

To what extent does this person exhibit Excellence?
Select from one of the ratings below.

Not Applicable or Unable to Judge

Poor does not perform to expected standards; often unable to complete tasks; does not seek help or advice

Minimal completes tasks only when pressured to do so; is satisfied with minimal progress; only does what is required

Average completes tasks easily; seeks to obtain maximal performance; willing to seek advice and help when needed

Role Model is a role model for others to follow; goes above and beyond what is expected; helps others

Continual Learning

What does Continual Learning mean?
It means that ...

• You pursue learning that will enhance job performance.
• You take the initiative to learn new skills.
• You build on your strengths while addressing your weaknesses.
• You are open to new ideas and concepts.
• You pursue self-improvement through continual learning.

To what extent does this person exhibit Continual Learning?
Select from one of the ratings below.

Not Applicable or Unable to Judge

Poor does not perform to expected standards; often unable to complete tasks; does not seek help or advice

Minimal completes tasks only when pressured to do so; is satisfied with minimal progress; only does what is required

Average completes tasks easily; seeks to obtain maximal performance; willing to seek advice and help when needed

Role Model is a role model for others to follow; goes above and beyond what is expected; helps others

Delegation

What does Delegation mean?
It means that ...

• You communicate trust in employees' judgment, reinforcing ownership and accountability.
• You assign challenging responsibilities to boost employee professional development while maintaining engagement.
• I offer work that aligns with career aspirations.
• I review workload distribution to avoid duplication or gaps in accountability.
• I specify expected outcomes, timelines, and success criteria for each delegated task.

To what extent does this person exhibit Delegation?
Select from one of the ratings below.

Not Applicable or Unable to Judge

Poor does not perform to expected standards; often unable to complete tasks; does not seek help or advice

Minimal completes tasks only when pressured to do so; is satisfied with minimal progress; only does what is required

Average completes tasks easily; seeks to obtain maximal performance; willing to seek advice and help when needed

Role Model is a role model for others to follow; goes above and beyond what is expected; helps others

Global Perspective

What does Global Perspective mean?
It means that ...

• You accept setbacks and challenges in foreign markets as improvement opportunities
• You create an environment where individual differences are valued and supported.
• You build working relationships with others across cultures.
• You respect individual differences.
• You exemplify the skills of a global worker.

To what extent does this person exhibit Global Perspective?
Select from one of the ratings below.

Not Applicable or Unable to Judge

Poor does not perform to expected standards; often unable to complete tasks; does not seek help or advice

Minimal completes tasks only when pressured to do so; is satisfied with minimal progress; only does what is required

Average completes tasks easily; seeks to obtain maximal performance; willing to seek advice and help when needed

Role Model is a role model for others to follow; goes above and beyond what is expected; helps others

Strengths


Areas for Development


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