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 demonstrate compassion and respect for others through actions; is concerned about their work and non-work issues
You act as an effective team player
You willingly share your technical expertise
You facilitate team discussions and problem-solving
You come across as a reliable, committed team member
Accountability	Role Model	Capable and Effective	Somewhat Effective	Needs Development
You accept accountability for your actions and results.
You keep you supervisor informed of recent events.
You are aware of problems or issues that may affect the organization.
You take responsibility for results.
You are someone who is trustworthy.
Passion To Learn	Role Model	Capable and Effective	Somewhat Effective	Needs Development
You embrace new technology and procedures.
You keep up-to-date with your skills.
You demonstrate through personal behavior the commitment to high standards of performance.
You enjoy learning new skills and techniques.
You enroll in continuing education courses.
Managing Performance	Role Model	Capable and Effective	Somewhat Effective	Needs Development
You use timely and appropriate corrective/disciplinary actions.
You create clear standards that are understandable and fair.
You monitor performance on a regular basis.
You review job performance shortly after completion of tasks.
You recognize and value good performance.
Persuasion and Influence	Role Model	Capable and Effective	Somewhat Effective	Needs Development
You seek to obtain consensus or compromise.
You understand what others need.
You communicate effectively with others.
You attempt to persuade others rather than simply control them.
You persuade others to consider alternative points of view.
Administrative Skill	Role Model	Capable and Effective	Somewhat Effective	Needs Development
You have strong organizational skills to keep the workspace and department in order
You are able to develop, justify and present a budget.
You take responsibility for decisions.
You implement and use performance measures.
You have strong technical/computer skills.
Commitment To Result	Role Model	Capable and Effective	Somewhat Effective	Needs Development
You take immediate action toward goals.
You coordinate all department activities into a cohesive team effort.
You create a sense of urgency among the store team members to complete activities, which drive sales.
You are committed to the team.
You are willing to do whatever it takes-not afraid to have to put in extra effort.
Excellence	Role Model	Capable and Effective	Somewhat Effective	Needs Development
You demonstrate the analytical skills to do your job.
You are planful and organized.
You produce high quality work.
You take a lot of pride in your work.
You can be counted on to add value wherever you are involved.
Customer Focus	Role Model	Capable and Effective	Somewhat Effective	Needs Development
You anticipate potential obstacles to meeting customer needs.
I tailor innovative products for each customer.
You put customer's needs first.
You document customer interactions.
You provide a high level of service to customers.
Strategic Focus	Role Model	Capable and Effective	Somewhat Effective	Needs Development
You sustain or achieves a competitive advantage for the organization by analyzing the best practices and lessons learned from other organizations.
You monitor performance of each market within the Area, utilizing reports to ensure sales growth, cost management, and profitability targets are met.
You are able to decline a poor strategy by proposing alternate strategies.
You communicate goals and objectives to employees.
You understand your role within the organization.

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.