Trustworthy - 360 Degree Feedback Survey Sample #5

360-Degree Assessment Survey

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
Delivers on promises made.
Works in a way that makes others want to work with her/him.
Is trustworthy; is someone I can trust.
Consistently keeps commitments.
Takes care to maintain confidential information.
Administrative Skill	Role Model	Capable and Effective	Somewhat Effective	Needs Development
High attention to detail.
Strong organizational skills to keep the workspace and department in order
Accurately implements contract provisions.
Completes reports on-time.
Implements and uses performance measures.
Flexibility	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Effective in incorporating new ideas.
Able to adapt to new situations.
Works effectively during periods of change.
Adapts to circumstances as needed.
Identifies new opportunities to achieve goals
Attitude	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Builds open and trusting relationships.
Contributes to a positive and fun work environment.
Treats all people fairly and with respect.
Contributes to a positive work environment.
Shows by their actions that they trust in the positive intentions of others.
Emotional Intelligence	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Is attentive to emotional cues and interprets others' feelings correctly.
Is able to express themselves clearly.
Is able to control their own emotions.
Helps to make decisions and solve problems using knowledge about how others will react in certain situations.
Accurately perceives the emotional reactions of others.
Managing Performance	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Provides employees with necessary resources to accomplish their goals.
Presents performance feedback in a clear and concise manner.
Creates clear standards that are understandable and fair.
Is consistent in disciplinary/corrective actions.
Obtains commitment from employees regarding completion of tasks.
Safety	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Identifies and addresses safety needs.
Ensures that all supervisors are aware of regulatory and compliance measures.
Participates in safety training when offered.
Is not afraid to question a potential safety issue observed in the workplace.
Works to implement corrective safety measures.
Vision	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Creates a common vision for others.
Works to support the strategy of [Company]
Expresses the Company vision in a way that is easily understood and adopted by employees.
Leads employees in new directions.
Clearly articulates a vision for his/her work and inspires others to support it

41. Overall, please rate the effectiveness of [Participant Name Here].
    

    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 [Participant Name Here]'s assessment.