Responsibility - 360 Degree Feedback Survey Sample #12

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.

Responsible

• Works in a way that makes others want to work with her/him.
• Is a person you can trust.
• Acts as a resource without removing individual responsibility.
• Responsible for setting the vision of the department.
• ...takes personal responsibility for results.

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

Comments:

Management

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

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

Comments:

Innovation

• Fosters a creative and innovative work environment.
• Finds creative ways to get things done with limited resources.
• Fosters a culture of disruptive innovation to drive significant market shifts and create unparalleled value for customers.
• Improves and makes systems more efficient.
• Supports changes to the standard way of doing things.

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.
• Maximizes the use of new technology to deliver products and services.
• Supports technical training and development of employees.
• Applies complex rules and regulations to maintain optimal system performance.

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

Comments:

Company

• 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.
• Attends [Company] gatherings and social events.
• Impresses upon others the important aspects of [Company].

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.