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
Works cooperatively with others to solve problems.
Encourages collaboration with other departments.
Communicates a clear message that teamwork and collaboration are expected.
Contributes to and supports team decision-making process
Relates to all kinds of people tactfully
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
Open to the perspectives/viewpoints of others.
Can handle changes without complaining.
Identifies new opportunities to achieve goals
Adapts to new organizational structures, policies, or procedures.
Able to adapt to new situations.
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
Ability to recognize the potential benefits of change, and create an infrastructure which supports change.
Performs a wide range of tasks, responds to changes in direction and priorities and accepts new challenges, responsibilities, and assignments.
Able to adapt to changes in technology and processes.
Willing to change ideas or perceptions based on new information or contrary evidence which is presented.
Learns from personal experiences and/or mistakes.
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.
Actively seeks feedback from others.
Looks to others for input.
Considers other's opinion and suggestions.
Asks others for their ideas and opinions.
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
Shows respect in daily interactions
Recognizes and values individual and cultural differences.
Fosters a diverse workforce free from discrimination and harassment.
Seeks out different viewpoints and benefits from different perspectives.
Treats others with dignity and respect.
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
Encourages employees to achieve their full potential.
Is aware of the unique strengths of each employee.
Maintains good working relationships with employees.
Appropriately recognizes and rewards employees.
Delegates effectively.
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
Sets clearly defined goals.
Completes tasks ahead of schedule.
Prioritizes tasks to identify immediate and long-term objectives.
Leaves time in the schedule for unplanned contingencies.
Deals effectively with interruptions.
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
Commits adequate resources toward safety measures.
Supports safety programs and procedures.
Participates in safety training as applicable.
Creates accurate and effective measures of safety.
Ensures that all supervisors are aware of regulatory and compliance measures.
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.