Teamwork- 360 Degree Feedback Survey Sample #12





360 Feedback Survey

Assessments Measuring Teamwork:
Survey 1 (4-point scale; Competency Comments)
Survey 2 (4-point scale; Competency Comments)
Survey 3 (5-point scale; Competency Comments)
Survey 4 (5-point scale; radio buttons)
Survey 5 (4-point scale; words)
Survey 6 (4-point scale; words)
Survey 7 (5-point scale; competency comments; N/A)
Survey 8 (3-point scale; Agree/Disagree words; N/A)
Survey 9 (3-point scale; Strength/Development; N/A)
Survey 10 (Comment boxes only)
Survey 11 (Single rating per competency)
Survey 12 (Slide-bar scale)
Instructions

Thank you for providing feedback for the recipient above. As you respond, please draw on your first-hand experience with this individual in the past 12 months. Rate each item using the scale shown. If you don't feel you have enough first-hand information to rate a certain item, please choose the Not Applicable option. Comments can be very helpful; at a minimum where you give a particularly high or low rating, please share your reasons in the comment section for that competency. Your responses will be compiled with feedback from others and presented to the recipient to help guide their ongoing development.

Competencies Included:
Teamwork, Performance, Results Oriented, Safety, Entrepreneurship
Sample Result Document:
Sample Results
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.

To what extent does [Participant Name] exhibit the following ...

SELECT the rating that best reflects the employee's performance in the areas listed.


Teamwork

  • Relates to all kinds of people tactfully
  • Comes across as a reliable, committed team member
  • Facilitates effective teamwork during periods of change.
  • Treats other team members with respect.
  • Takes the time to actively listen to other team member's perspectives.
Needs
Improvement		 Fully
Proficient		 Excels/
Role Model






Click this box to make your rating
Comments:

Performance

  • Sets a high standard for job performance.
  • Effectively organizes resources and plans
  • ...Overall Performance
  • Works well in this position.
  • Has great overall performance
Needs
Improvement		 Fully
Proficient		 Excels/
Role Model






Click this box to make your rating
Comments:

Results Oriented

  • Views obstacles as opportunities to improve self.
  • Makes sure employees have the resources they need to achieve their results.
  • Determined to complete tasks regardless of obstacles that may occur.
  • Exceeds performance requirements.
  • Recognizes the problem that needs to be solved.
Needs
Improvement		 Fully
Proficient		 Excels/
Role Model






Click this box to make your rating
Comments:

Safety

  • Supports our company's safety programs.
  • Seeks to reduce the likelihood of accidents.
  • Participates in safety training when offered.
  • Participates in safety training when available.
  • Creates accurate and effective measures of safety.
Needs
Improvement		 Fully
Proficient		 Excels/
Role Model






Click this box to make your rating
Comments:

Entrepreneurship

  • Encourages dynamic growth opportunities.
  • Has a strategic awareness on how to promote the organization.
  • Exhibits determination and passion in completion of goals.
  • Maintains a high level of energy to respond to demands of the job.
  • Balances risks and rewards when making decisions.
Needs
Improvement		 Fully
Proficient		 Excels/
Role Model






Click this box to make your rating
Comments:
Strengths


Areas for Development


Please give any final comments or suggestions for [Participant Name Here]'s assessment.