Teamwork- 360 Degree Feedback Survey Sample #7

360 Feedback Survey

Instructions

is administering a new web-based survey tool which is designed to gather broad feedback as it relates to core competencies and role responsibilities that are important for the on-going success of our organization. The Leadership Team Members have agreed to participate and are seeking your feedback.

In this regard, you have been selected to provide feedback for the manager listed above. Your feedback is an important part of 's leadership development process. This tool is intended to gather broad feedback in the core competencies and role responsibilities that are important for the on-going success of our organization.

In responding to the assessment form, please think about your experiences working with this individual during the last twelve (12) months. Your responses will be merged with other people's feedback and presented to guide them in their on-going development. Comments will be shared anonymously, as written, with the manager, unless you indicate otherwise.

You are only being asked to rate 8 competencies. Each competency will have a variety of statements that are grouped by 4 Performance Levels. Click on the level that best describes this individual.

Please ensure that your submission is made between .

Teamwork	Needs Improvement		Fully Proficient		Excels/ Role Model	Not Applicable
Comes across as a reliable, committed team member
Encourages others to share ideas to develop team cohesion
Encourages open communication
Builds consensus and shares relevant information.
Creates a culture that fosters and values collaboration.
If [Participant Name] were to make improvements in Teamwork, what are your suggestions for how he/she can improve this?
Flexibility	Needs Improvement		Fully Proficient		Excels/ Role Model	Not Applicable
Works effectively during periods of change.
Open to the perspectives/viewpoints of others.
Adapts to new organizational structures, policies, or procedures.
Effective in incorporating new ideas.
Acts decisively in frequently changing and uncertain environment.
If [Participant Name] were to make improvements in Flexibility, what are your suggestions for how he/she can improve this?
Adaptability	Needs Improvement		Fully Proficient		Excels/ Role Model	Not Applicable
Adapts to diversity within the team.
Recognizes and implements changes to enhance efficiency and effectiveness.
Is aware of changes to the policies and procedures.
Able to step in and help co-workers when needed.
Adjusts plans as needed based on changing conditions.
If [Participant Name] were to make improvements in Adaptability, what are your suggestions for how he/she can improve this?
Feedback	Needs Improvement		Fully Proficient		Excels/ Role Model	Not Applicable
Shares past experiences with others as learning opportunities.
Is visible and approachable.
Considers other's opinion and suggestions.
Looks to others for input.
Actively seeks feedback from others.
If [Participant Name] were to make improvements in Feedback, what are your suggestions for how he/she can improve this?
Cultural Awareness	Needs Improvement		Fully Proficient		Excels/ Role Model	Not Applicable
Respects the views offered by individuals with different cultural backgrounds.
Respects others regardless of age, race, gender, nationality, or disability.
Develops skills and attitudes to bridge cultural differences.
Is willing to include individuals with different cultural backgrounds on the team.
Engages with individuals that have different cultural backgrounds.
If [Participant Name] were to make improvements in Cultural Awareness, what are your suggestions for how he/she can improve this?
Supervisory Skills	Needs Improvement		Fully Proficient		Excels/ Role Model	Not Applicable
Sets a good example for others to follow.
Demonstrates exemplary work performance that others should follow.
Listens to others.
Resolves disputes in a way that quickly reaches mutual agreement.
Is able to manage emotions during difficult times.
If [Participant Name] were to make improvements in Supervisory Skills, what are your suggestions for how he/she can improve this?
Time Management	Needs Improvement		Fully Proficient		Excels/ Role Model	Not Applicable
Prioritizes new tasks according to their relative importance.
Makes time for developing plans and schedules.
Leaves time in the schedule for unplanned contingencies.
Completes tasks ahead of schedule.
Focuses on tasks that have high priority.
If [Participant Name] were to make improvements in Time Management, what are your suggestions for how he/she can improve this?
Safety	Needs Improvement		Fully Proficient		Excels/ Role Model	Not Applicable
Ensures compliance with safety regulations.
Develops a culture of safety.
Encourages others to work safely.
Commits adequate resources toward safety measures.
Committed to safety in the workplace.
If [Participant Name] were to make improvements in Safety, what are your suggestions for how he/she can improve this?

41. Strengths
    
    
    
42. Areas for Development
    
    
    
43. Please give any final comments or suggestions for [Participant Name Here]'s assessment.