Self-Management - 360 Degree Feedback Survey Sample #10

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.

You can save your progress on partially completed forms by clicking the Save/Still Working button located at the bottom of the page. This allows you to come back at a later time to finish or make any necessary edits to the form. When you return, your previously saved responses will automatically be displayed, allowing you to seamlessly continue where you left off. When you have completed filling out the form and are confident that no further changes are needed, please click the Complete button.

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Self Management

• Uses patience and self-control in working with customers and associates.
• Analyzes own reactions on the spot to ensure that communication does not appear to be driven by anger.
• Deals with conflict by controlling own emotions by listening, being flexible, and sincere in responding.
• Analyzes interpersonal problems instead of reacting to them.
• 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?

Creativity

• Regularly asks probing questions to uncover deeper possibilities.
• Creates space for every voice to contribute creatively.
• Builds buffer time into schedules to allow for reflection and idea development.
• Respects the need for quiet time to support deep creative thinking.
• Imagines new products, services, or processes before they're needed.

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

Initiative

• Is an inspiration for others to perform above expectations.
• Leads pilots or experiments that result in scalable improvements.
• Initiates draft reports for consideration.
• When working on a problem in a team, they are often the first to suggest possible solutions.
• Is motivated to resolve issues right away.

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

Results Oriented

• Persists in seeking objectives despite obstacles or setbacks.
• Keeps track of progress toward the results.
• Recognizes and rewards employees who consistently take ownership of their work.
• Creates measures of performance to track progress.
• Gives extra effort to solve problems and get work done on time.

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

Safety

• Develops a strong safety culture.
• Develops safety guidelines for the department.
• Keeps accurate safety records.
• Encourages others to work safely.
• Develops a culture of safety.

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.
• Responsible for setting the vision of the department.
• Is a person you can trust.
• Acts as a resource without removing individual responsibility.
• 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.