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

• Sets an example for associates during stressful periods by maintaining a positive, can-do attitude.
• Uses patience and self-control in working with customers and associates.
• Steps away from a situation to process appropriate response.
• 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.

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.
• Develops solutions to challenging problems.
• Is creative and inspirational.
• Is creative.
• Conceives, implements and evaluates ideas.

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

Initiative

• Takes charge when there is a crisis.
• Updates the documentation as soon as the situation changes.
• Initiates draft reports for consideration.
• Immediately works to complete goals well before their deadline.
• Seizes upon chances to improve the department's prospects.

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

Results Oriented

• Willing to take on new assignments to help increase production.
• Recognizes the problem that needs to be solved.
• Stays focused on meeting the needs of customers.
• Pursues performance benchmarks despite obstacles and setbacks.
• Persists in seeking objectives despite obstacles or setbacks.

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

Safety

• Seeks to reduce the likelihood of accidents.
• Is aware of OSHA safety guidelines.
• Works to implement corrective safety measures.
• Identifies predictable hazards in the workplace.
• Ensures compliance with safety regulations.

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

Responsible

• Sets high personal standards of performance.
• Responsible for setting the vision of the department.
• ...takes personal responsibility for results.
• Completes assigned work tasks.
• Works in a way that makes others want to work with her/him.

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.