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

• Steps away from a situation to process appropriate response.
• Consciously controls own negative emotions in order to keep team morale up.
• 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.
• Sets an example for associates during stressful periods by maintaining a positive, can-do attitude.

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

Creativity

• Creates a lot of new ideas.
• Is creative and inspirational.
• Inspires creativity in their team.
• Conceives, implements and evaluates ideas.
• Is creative.

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

Initiative

• Gladly seeks additional responsibilities.
• Anticipates problems and initiates plans to address them.
• Addresses small problems before they become big ones.
• Acts quickly when an opportunity becomes available.
• Builds strong interpersonal relationships upon first meeting.

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

Results Oriented

• Views obstacles as opportunities to improve self.
• Completes all required coursework.
• Focuses on achieving important goals.
• Concentrates efforts on the most urgent needs.
• Achieves high levels of performance.

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

Safety

• Encourages others to work safely.
• Develops a sustainable safety culture.
• Keeps accurate safety records.
• Points out behaviors in others that may be unsafe.
• 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

• Behavior is ethical and honest.
• Acts as a resource without removing individual responsibility.
• Completes assigned work tasks.
• ...takes personal responsibility for results.
• Sets a good example.

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.