Self-Management - 360 Degree Feedback Survey Sample #5

360-Degree Assessment Survey

Dear Employee:

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 Closing Comments section. 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.

Please ensure that your submission is made by .

Thank you for your participation in the survey.

Management Team

Self Management	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Is aware of personal impact on others and adjusts behavior to create a positive leadership presence.
Consciously controls own negative emotions in order to keep team morale up.
Does not allow own emotions to interfere with the performance of others.
Uses patience and self-control in working with customers and associates.
Deals with conflict by controlling own emotions by listening, being flexible, and sincere in responding.
Creativity	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Inspires creativity in their team.
Creates a lot of new ideas.
Conceives, implements and evaluates ideas.
Is creative and inspirational.
Is creative.
Cultural Awareness	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Respects others regardless of age, race, gender, nationality, or disability.
Shows respect in daily interactions
Recognizes and values individual and cultural differences.
Seeks out different viewpoints and benefits from different perspectives.
Values the opinions of diverse groups and individual.
Problem Solving	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Ability to solve problems at root cause rather than at symptom level.
Works cooperatively with others to solve problems.
Is a good problem solver and decision maker
Effective in solving problems.
Makes judgments based upon relevant information.
Juggling Multiple Responsibilities	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Ranks the importance of tasks to make sure critical tasks are completed first.
Recognizes and responds to product placement and signing needs while staying alert to customers' needs, store activities and training associates.
Integrates developing others with driving sales, serving customers, merchandising, performing operational procedures, and maintaining an appealing store environment.
Ensures that assignments are prioritized according to the needs of the department/company.
Switches attention to more urgent tasks when necessary.
Clarity	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Checks details thoroughly.
Clearly explains the vision and goals of the company.
Seeks to reduce ambiguity in messaging and documents.
Communicates with clarity and efficiency.
Adjusts communication methods to the needs of the audience.
Regulatory/Compliance	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Ensures the company meets legal requirements/standards regarding employees.
Addresses issues quickly before they develop into major problems.
Offers training on various subjects to help ensure employees are aware of regulations.
Maintains a state of readiness to address new and changing regulations and procedures.
Works quickly to implement changes in regulations.
Partnering/Networking	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Develops a sense of trust in subordinates so they can freely interact and share information with others.
Creates the conditions for partnerships to grow and develop.
Capitalizes on partnerships and networks to enhance the Company's bottom line.
Forges mutually beneficial relationships between individuals with diverse backgrounds.
Supports a partnering/networking culture.

41. Overall, please rate the effectiveness of [Participant Name Here].
    

    5- Very Effective 4- Effective 3- Neither 2- Ineffective 1- Very Ineffective

    
    
42. Strengths
    
    
    
43. Areas for Development
    
    
    
44. Please give any final comments or suggestions for [Participant Name Here]'s assessment.