Responsibility - 360 Degree Feedback Survey Sample #12

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

• Sets a good example.
• Completes assigned work tasks.
• Holds herself / himself accountable to goals / objectives
• Acts as a resource without removing individual responsibility.
• Works in a way that makes others want to work with her/him.

Needs Improvement		Fully Proficient		Excels/ Role Model
Click this box to make your rating

Comments:

Management

• Sets an example for others to follow
• Delegate tasks effectively
• Is ready to offer help
• Makes you feel enthusiastic about your work
• Keep staff informed about what is happening in the company

Needs Improvement		Fully Proficient		Excels/ Role Model
Click this box to make your rating

Comments:

Innovation

• Challenges current procedures to develop other alternatives.
• Builds upon the ideas and solutions of others.
• Offers constructive improvements to existing systems.
• Implements best practices within the department.
• Takes risks to advance important ideas.

Needs Improvement		Fully Proficient		Excels/ Role Model
Click this box to make your rating

Comments:

Technology Use/Management

• Uses technology in decision making and problem solving.
• Supports employee training and development initiatives regarding implementation of technology.
• Supports technical training and development of employees.
• Proficient in the use of technical systems and processes.
• Understands and is committed to implementing new technologies.

Needs Improvement		Fully Proficient		Excels/ Role Model
Click this box to make your rating

Comments:

Company

• Attends [Company] gatherings and social events.
• Follows existing procedures and processes.
• Understands how decisions impact other business units beyond their immediate department of work group.
• Understands the "basics" as to how [Company] functions/operates.
• Expresses loyalty and dedication to [Company] in interactions with others.

Needs Improvement		Fully Proficient		Excels/ Role Model
Click this box to make your rating

Comments:

Strengths


Areas for Development


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