Self-Management - 360 Degree Feedback Survey Sample #1





360-Degree Feedback Survey

Questionnaires Measuring Self-Management:
Survey 1 (4-point scale; Competency Comments)
Survey 2 (4-point scale; Competency Comments)
Survey 3 (5-point scale; Competency Comments)
Survey 4 (5-point scale; radio buttons)
Survey 5 (4-point scale; words)
Survey 6 (4-point scale; words)
Survey 7 (5-point scale; competency comments; N/A)
Survey 8 (3-point scale; Agree/Disagree words; N/A)
Survey 9 (3-point scale; Strength/Development; N/A)
Survey 10 (Comment boxes only)
Survey 11 (Single rating per competency)
Survey 12 (Slide-bar scale)
Instructions:

[Company] is conducting a 360-Degree Feedback Assessment developed by HR-Survey for selected managers.

You have been selected to provide feedback on the employee listed above. Your feedback is an important part of our company's leadership development process and this survey is intended to gather broad feedback in the core competencies and role responsibilities that are important for the on-going success of our organization.

In responding to the questions below, think about your experiences working with this employee over the last twelve months. The effectiveness of this development tool is dependent on your honest, forthright and constructive responses so please bear this in mind as you answer each question. Your responses will be aggregated with the responses received from others and discussed with the employee to foster growth and on-going 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.

Competencies Included:
Self-Management, Continual Improvement, Emotional Intelligence, Adaptability, Bias for Action, Supervisory Skills, Quality, Time Management, Commitment To Result, Technology Use/Management, Managing Risk, Responsible, Empowering Others, Others, Planning
Sample Result Document:
Sample Results
Your feedback is valuable in helping the individual to understand how they are perceived and experienced by others and the impact their behavior has on people in the organization with whom they interact. Feedback received also acknowledges strengths and identifies areas for development.

Use the form below to provide your feedback. Each field and comment box requires a response before you can SUBMIT your final feedback.

Please ensure that your submission is made between . The survey will only be available during these dates.

Thank you for your participation in the survey. We look forward to seeing the analysis of your responses and we are hoping for 100% participation.

Management Team


Self Management

Needs
Improvement
Meets
Minimum
Standards
Is
Proficient
Role
Model
  1. Uses patience and self-control in working with customers and associates.
  1. Consciously controls own negative emotions in order to keep team morale up.
  1. Does not allow own emotions to interfere with the performance of others.
  1. Is aware of personal impact on others and adjusts behavior to create a positive leadership presence.
If [Participant Name] were to make improvements in Self Management, what are your suggestions for how he/she can improve this?

Continual Improvement

Needs
Improvement
Meets
Minimum
Standards
Is
Proficient
Role
Model
  1. Encourages an employee culture of continuous improvement to seek out better ways of doing things.
  1. Looks for ways to expand current job responsibilities.
  1. Looks for ways to expand and learn new job skills.
  1. Open to the suggestions from others.
If [Participant Name] were to make improvements in Continual Improvement, what are your suggestions for how he/she can improve this?

Emotional Intelligence

Needs
Improvement
Meets
Minimum
Standards
Is
Proficient
Role
Model
  1. Is able to control their own emotions.
  1. Accurately perceives the emotional reactions of others.
  1. Able to understand others' points of view.
  1. Is able to manage their own emotions.
If [Participant Name] were to make improvements in Emotional Intelligence, what are your suggestions for how he/she can improve this?

Adaptability

Needs
Improvement
Meets
Minimum
Standards
Is
Proficient
Role
Model
  1. Willing to change ideas or perceptions based on new information or contrary evidence which is presented.
  1. Able to quickly learn new ways of performing their job.
  1. Adapts to changes in team membership.
  1. Adjusts plans to meet new situations.
If [Participant Name] were to make improvements in Adaptability, what are your suggestions for how he/she can improve this?

Bias for Action

Needs
Improvement
Meets
Minimum
Standards
Is
Proficient
Role
Model
  1. Completes a large volume of work.
  1. Encourages risk taking and experimentation to improve performance
  1. Displays high energy and enthusiasm on consistent basis.
  1. Projects a "can-do" attitude when interfacing with peers, subordinates and customers(especially during difficult and challenging times).
If [Participant Name] were to make improvements in Bias for Action, what are your suggestions for how he/she can improve this?

Supervisory Skills

Needs
Improvement
Meets
Minimum
Standards
Is
Proficient
Role
Model
  1. Is able to motivate others through persuasion rather than coercion.
  1. Contributes to a productive work environment for the team.
  1. Demonstrates exemplary work performance that others should follow.
  1. Conveys instructions, directives and guidelines to the employees.
If [Participant Name] were to make improvements in Supervisory Skills, what are your suggestions for how he/she can improve this?

Quality

Needs
Improvement
Meets
Minimum
Standards
Is
Proficient
Role
Model
  1. Influences others to achieve high quality standards.
  1. Is flexible in addressing issues related to quality.
  1. Able to anticipate quality issues and take preventative actions.
  1. Identifies appropriate sources of quality standards.
If [Participant Name] were to make improvements in Quality, what are your suggestions for how he/she can improve this?

Time Management

Needs
Improvement
Meets
Minimum
Standards
Is
Proficient
Role
Model
  1. Manages the workload effectively in order to stay on schedule.
  1. Uses a team and delegates tasks to specialists to help get more work done within the same amount of time.
  1. Stays undistracted by personal devices while on the clock.
  1. Prioritizes high value tasks at work.
If [Participant Name] were to make improvements in Time Management, what are your suggestions for how he/she can improve this?

Commitment To Result

Needs
Improvement
Meets
Minimum
Standards
Is
Proficient
Role
Model
  1. Takes immediate action toward goals.
  1. Coordinates all department activities into a cohesive team effort.
  1. Conveys strong sense of own pride in Company to associates by creating a shared vision around sales and customer service.
  1. Encourages commitment in others to obtain results.
If [Participant Name] were to make improvements in Commitment To Result, what are your suggestions for how he/she can improve this?

Technology Use/Management

Needs
Improvement
Meets
Minimum
Standards
Is
Proficient
Role
Model
  1. Identifies gaps between actual and needed technical competencies and provides recommendations for required training.
  1. Maximizes the use of new technology to deliver products and services.
  1. Supports employee training and development initiatives regarding implementation of technology.
  1. Adopts the implementation of new technology into the workplace.
If [Participant Name] were to make improvements in Technology Use/Management, what are your suggestions for how he/she can improve this?

Managing Risk

Needs
Improvement
Meets
Minimum
Standards
Is
Proficient
Role
Model
  1. Is aware of process safety management.
  1. Tracks and monitors incidents that may increase the risk of adverse consequences.
  1. Identifies and mitigates risks while making informed, strategic decisions.
  1. Aware of appropriate actions to minimize risks.
If [Participant Name] were to make improvements in Managing Risk, what are your suggestions for how he/she can improve this?

Responsible

Needs
Improvement
Meets
Minimum
Standards
Is
Proficient
Role
Model
  1. Is a person you can trust.
  1. Holds herself / himself accountable to goals / objectives
  1. Sets high personal standards of performance.
  1. Behavior is ethical and honest.
If [Participant Name] were to make improvements in Responsible, what are your suggestions for how he/she can improve this?

Empowering Others

Needs
Improvement
Meets
Minimum
Standards
Is
Proficient
Role
Model
  1. Lets employees complete tasks according to their methods.
  1. Trusts employees to complete tasks assigned.
  1. Enables team members to make their own decisions on the project.
  1. Recognizes the accomplishments of employees when they complete important assignments.
If [Participant Name] were to make improvements in Empowering Others, what are your suggestions for how he/she can improve this?

Others

Needs
Improvement
Meets
Minimum
Standards
Is
Proficient
Role
Model
  1. Works across boundaries within the organization.
  1. ...treats others with respect and dignity.
  1. Treats others with respect and dignity.
  1. Works effectively with people from other departments.
If [Participant Name] were to make improvements in Others, what are your suggestions for how he/she can improve this?

Planning

Needs
Improvement
Meets
Minimum
Standards
Is
Proficient
Role
Model
  1. Allows input from others for the 5-year plan.
  1. Anticipates potential challenges, develops plan to overcome them and then carries out the plan.
  1. Determines the steps required for completion of a task.
  1. Ensures staff have the supplies and resources necessary to enact the plan.
If [Participant Name] were to make improvements in Planning, what are your suggestions for how he/she can improve this?

  1. What are [Participant Name Here]'s greatest strengths demonstrated this year?


  2. What are [Participant Name Here]'s areas for development?


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