Responsibility - 360 Degree Feedback Survey Sample #11

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.

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

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

Responsible

What does Responsible mean?
It means that ...

• You take personal responsibility for results.
• You complete assigned work tasks.
• You set a good example
• You hold yourself accountable to goals / objectives
• You work in a way that makes others want to work with you.

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

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 improve on your skill sets.
• You pursue learning that will enhance job performance.
• You share best practices with others and learn from others.
• You build on your strengths while addressing your weaknesses.
• You are open to new ideas and concepts.

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 assign tasks to create learning opportunities for the employees.
• You define the roles, responsibilities, required actions, and deadlines for team members.
• You set clear and reasonable expectations for others and follow through on their progress.
• You encourage and empower subordinates to use initiative in achieving goals and objectives.
• You tell subordinates what to do, not how to do it.

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 are able to listen and understand others and discuss issues in a respectful way.
• You collaborate with others respectfully and effectively with other people regardless of differences in cultural backgrounds.
• You attend training seminars and conferences to increase skills in working with others globally.
• You understand global systems such as the global economy.
• You demonstrate a curiosity about diverse individuals and cultures.

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.