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

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

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

Comments:

Management

• Takes responsibility for things that go wrong
• Keep staff informed about what is happening in the company
• Makes you feel enthusiastic about your work
• Is ready to offer help
• Sets an example for others to follow

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

Comments:

Innovation

• Creates improved methods or solutions for meeting goals and objectives.
• Suggests new ideas at meetings.
• Implements best practices within the department.
• Creates a safe environment for idea-sharing.
• Finds creative ways to get things done with limited resources.

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

Comments:

Technology Use/Management

• Supports employee training and development initiatives regarding implementation of technology.
• Identifies gaps between actual and needed technical competencies and provides recommendations for required training.
• Understands and is committed to implementing new technologies.
• Supports technical training and development of employees.
• Adopts the implementation of new technology into the workplace.

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

Comments:

Company

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

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.