Teamwork- 360 Degree Feedback Survey Sample #5

360-Degree Assessment Survey

Dear Employee:

Thank you for participating in a 360-degree feedback assessment. In this process, you will complete a self-assessment questionnaire (below). You will also receive feedback from others including your manager, peers and direct reports. As you respond, please respond using just your experiences in the past 12 months. Rate each item using the scale shown. Comments can be very helpful; at a minimum where you give a particularly high or low rating, please share your reasons in the Closing Comments section.

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.

Please ensure that your submission is made by .

Thank you for your participation in the survey.

Management Team

Teamwork	Role Model	Capable and Effective	Somewhat Effective	Needs Development
You coach team on how to solve problems, plan, and meet organizational goals and objectives.
You identify and resolves conflicts within the team to increase team effectiveness
You are an effective team player
You work cooperatively with others to solve problems.
You actively participates as a team member
Accountability	Role Model	Capable and Effective	Somewhat Effective	Needs Development
You accept responsibility for outcomes.
You keep your word and do what you say you will do.
You create a consistent process for prioritizing work.
You require employees provide you with advanced warning on problems and issues that they know will affect completion of tasks.
You take ownership of mistakes and learn from them.
Passion To Learn	Role Model	Capable and Effective	Somewhat Effective	Needs Development
You are open to feedback from others.
You are willing to learn new procedures for working with the equipment.
You hold self and associates accountable for goal achievement.
You demonstrate through personal behavior the commitment to high standards of performance.
You critique own performance and learn from experience as a source of continuous improvement.
Managing Performance	Role Model	Capable and Effective	Somewhat Effective	Needs Development
You measure job performance of subordinates against defined goals and objectives.
You review job performance shortly after completion of tasks.
You address poor performance sooner rather than later.
You set and maintain high standards for self and others.
You ensure that team goals are met 85 percent of the time.
Persuasion and Influence	Role Model	Capable and Effective	Somewhat Effective	Needs Development
You communicate effectively with others.
You are able to express own goals and needs.
You develop a good rapport with others.
You understand what others need.
You have excellent influencing/negotiating skills.
Administrative Skill	Role Model	Capable and Effective	Somewhat Effective	Needs Development
You take responsibility for decisions.
You implement and use performance measures.
You have strong organizational skills to keep the workspace and department in order
You accurately implement contract provisions.
You complete reports on-time.
Commitment To Result	Role Model	Capable and Effective	Somewhat Effective	Needs Development
You maintain persistence and dedication to achieving results.
You are able to focus on a task even when working alone.
You convey strong sense of own pride in Company to associates by creating a shared vision around sales and customer service.
You are committed to the team.
You encourage commitment in others to obtain results.
Excellence	Role Model	Capable and Effective	Somewhat Effective	Needs Development
You can be counted on to add value wherever you are involved.
You produce high quality work.
You are planful and organized.
You demonstrate the analytical skills to do your job.
You demonstrate the functional or technical skills necessary to do your job.
Customer Focus	Role Model	Capable and Effective	Somewhat Effective	Needs Development
You ensure all customer commitments and requirements are met or exceeded.
You develop good rapport and trust with the customer.
You maintain positive customer relationships.
You consider customers point of view when making decisions.
You consistently model positive customer service attitudes.
Strategic Focus	Role Model	Capable and Effective	Somewhat Effective	Needs Development
You communicate goals and objectives to employees.
You understand your role within the organization.
You understand and contribute to development of strategic goals.
You create plans to develop and promote organizational and area strengths, as well as to address weaknesses.
You look for opportunities to enhance contributions to the bottom line.

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

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

    
    
52. Strengths
    
    
    
53. Areas for Development
    
    
    
54. Please give any final comments or suggestions for [Participant Name Here]'s assessment.