Self-Management - 360 Degree Feedback Survey Sample #10

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.

Self Management

• Is aware of personal impact on others and adjusts behavior to create a positive leadership presence.
• Analyzes own reactions on the spot to ensure that communication does not appear to be driven by anger.
• Does not allow own emotions to interfere with the performance of others.
• Consciously controls own negative emotions in order to keep team morale up.
• Uses patience and self-control in working with customers and associates.

If [Participant Name] were to make improvements in Self Management, what are your suggestions for how he/she can improve this?

Creativity

• Adds value to the department/organization.
• Is creative.
• Inspires creativity in their team.
• Is creative and inspirational.
• Creates a lot of new ideas.

If [Participant Name] were to make improvements in Creativity, what are your suggestions for how he/she can improve this?

Initiative

• Initiates actions that impact the department/company.
• Initiates important conversation topics at meetings.
• Initiates projects that have an impact on the department.
• Takes action to implement new changes in the policies and procedures.
• Actively works on resolving the issue instead of procrastinating or hoping it will resolve itself.

If [Participant Name] were to make improvements in Initiative, what are your suggestions for how he/she can improve this?

Results Oriented

• Stays focused on meeting the needs of customers.
• Demonstrates the personal confidence to "stay the course," even when faced with difficulty
• Works toward achievement of goals even when confronted with obstacles.
• Helps others when free-time is available.
• Directs team in prioritizing daily work activities

If [Participant Name] were to make improvements in Results Oriented, what are your suggestions for how he/she can improve this?

Safety

• Identifies predictable hazards in the workplace.
• Develops a culture of safety.
• Creates accurate and effective measures of safety.
• Supports our company's safety programs.
• Encourages others to attend safety training.

If [Participant Name] were to make improvements in Safety, what are your suggestions for how he/she can improve this?

Responsible

• Completes assigned work tasks.
• Sets a good example.
• Works in a way that makes others want to work with her/him.
• Sets a good example
• Responsible for setting the vision of the department.

If [Participant Name] were to make improvements in Responsible, what are your suggestions for how he/she can improve this?

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

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

Strengths


Areas for Development


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