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 let team members know when they have done well.
I help other team members to research solutions to a problem.
I work with other team members to identify bottle necks in the production process.
I am open to alternative ways to accomplish goals suggested by the team.
You share pertinent information with all members of the team.
Accountability	Role Model	Capable and Effective	Somewhat Effective	Needs Development
You accept accountability for your work.
You implement and facilitate controls and processes that maintain the integrity of the organization.
You accept accountability for your actions and results.
You consistently strive to complete work on time or ahead of schedule.
You take responsibility for the team's actions and results.
Passion To Learn	Role Model	Capable and Effective	Somewhat Effective	Needs Development
You demonstrate a willingness to learn new things.
You seek to increase skill set.
You enroll in certification classes when available.
You inspire others to learn new things.
You exhibit willingness to upgrade skills through additional training and education.
Managing Performance	Role Model	Capable and Effective	Somewhat Effective	Needs Development
You reward employees for exceeding goals.
I train and develop employees to realize their maximum potential.
You hold employees accountable for meeting performance expectations.
You establish standards for expected performance.
You routinely hold audits of performance on a weekly or monthly basis.
Persuasion and Influence	Role Model	Capable and Effective	Somewhat Effective	Needs Development
You have excellent influencing/negotiating skills.
You understand what others need.
You communicate effectively with others.
You persuade others to consider alternative points of view.
You are able to express own goals and needs.
Administrative Skill	Role Model	Capable and Effective	Somewhat Effective	Needs Development
You are enthusiastic about taking on challenging projects.
You complete reports on-time.
You are able to develop, justify and present a budget.
You have strong technical/computer skills.
You have a high attention to detail.
Commitment To Result	Role Model	Capable and Effective	Somewhat Effective	Needs Development
You are willing to do whatever it takes-not afraid to have to put in extra effort.
You maintain persistence and dedication to achieving results.
You create a sense of urgency among the store team members to complete activities, which drive sales.
You are able to focus on a task even when working alone.
You take immediate action toward goals.
Excellence	Role Model	Capable and Effective	Somewhat Effective	Needs Development
You can be counted on to add value wherever you are involved.
You are planful and organized.
You take a lot of pride in your work.
You keep yourself and others focused on constant improvement.
You produce high quality work.
Customer Focus	Role Model	Capable and Effective	Somewhat Effective	Needs Development
You address customer complaints immediately.
I respond to feedback from customers.
I am available to respond to customer needs.
You use feedback from the customer to help improve the customer's experience.
You develop strong customer relationships.
Strategic Focus	Role Model	Capable and Effective	Somewhat Effective	Needs Development
I maintain a strategic focus to sustain competitiveness in changing business environments.
You avoid complacency and strives to be ahead of changes in the business environment.
I pursue strategic alliances with valued partners.
You caft and execute strategies to advance the company.
You coordinate the implementation of the strategy with stakeholders.

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.