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

• Does not allow own emotions to interfere with the performance of others.
• Steps away from a situation to process appropriate response.
• Uses patience and self-control in working with customers and associates.
• 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.

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.
• Creates a lot of new ideas.
• Is creative and inspirational.
• Develops solutions to challenging problems.
• 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

• Informs the manager of any important changes in the equipment operation.
• Is proactive when preparing for potential problems or critical events.
• Gladly seeks additional responsibilities.
• Acts quickly to address any issues or problems.
• Takes the initiative to complete tasks ahead of schedule.

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

Results Oriented

• Concentrates efforts on the most urgent needs.
• Produces a high volume of work.
• Has a strong drive to complete goals despite obstacles that may arise.
• Stays focused on meeting the needs of customers.
• Exceeds performance requirements.

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

Safety

• Develops a culture of safety.
• Identifies and addresses safety needs.
• Participates in safety training when offered.
• Develops a strong safety culture.
• Identifies predictable hazards in the workplace.

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

Responsible

• Works in a way that makes others want to work with her/him.
• Holds herself / himself accountable to goals / objectives
• Sets a good example.
• Acts as a resource without removing individual responsibility.
• Is a person you can trust.

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.