Trustworthy - 360 Degree Feedback Survey Sample #5

Dear Employee:

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 Closing Comments section. Your responses will be compiled with feedback from others and presented to the recipient to help guide their ongoing development.

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

Trustworthy	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Takes care to maintain confidential information.
Works in a way that makes others want to work with her/him.
Builds and maintains the trust of others.
Takes ownership, delivers on commitments
Demonstrates a sense of responsibility and commitment to public trust.
Administrative Skill	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Takes responsibility for decisions.
Enthusiastic about taking on challenging projects.
Implements and uses performance measures.
Accurately implements contract provisions.
Strong organizational skills to keep the workspace and department in order
Flexibility	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Works effectively during periods of change.
Identifies new opportunities to achieve goals
Willing to try new ideas.
Encourages others to adopt new procedures.
Able to adapt to new situations.
Attitude	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Visibly supports and encourages diversity in style and background.
Shows by their actions that they trust in the positive intentions of others.
Treats all people fairly and with respect.
Works to eliminate unnecessary work or barriers that get in others' way.
Builds open and trusting relationships.
Emotional Intelligence	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Able to understand others' points of view.
Is able to manage their own emotions.
Is able to control their own emotions.
Accurately perceives the emotional reactions of others.
Helps to make decisions and solve problems using knowledge about how others will react in certain situations.
Managing Performance	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Recognizes and values good performance.
Provides employees with necessary resources to accomplish their goals.
Examines the most effective ways for accomplishing goals.
Addresses grievances sooner rather than later.
Prioritizes the work of others.
Safety	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Participates in safety training when offered.
Committed to safety in the workplace.
Develops a sustainable safety culture.
Commits adequate resources toward safety measures.
Keeps accurate safety records.
Vision	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Demonstrates consistency between words and actions
Communicates the vision and strategy of [Company]
Leads employees in new directions.
Communicates a vision of where the Company needs to be in the future.
Understands the vision of the Company and promotes it ahead of any self-interests.

41. Overall, please rate the effectiveness of .
    

    5- Very Effective 4- Effective 3- Neither 2- Ineffective 1- Very Ineffective

    
    
42. Strengths
    
    
    
43. Areas for Development
    
    
    
44. Please give any final comments or suggestions for 's assessment.