Trustworthy - 360 Degree Feedback Survey Sample #8

Instructions

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 six to twelve months. Your responses will be merged with other people's feedback and presented to to guide them in their on-going development. Comments will be shared anonymously, as written, with the manager.

Method of use: As part of the review process, managers will receive feedback from peers and staff. It is recognized that not all participants will be able to assess an individual's performance in all areas. The feedback received will be utilized as input to the manager's performance and on-going development plan.

You may sign out at any time by pressing the Save button at the end of the form and then closing your browser. You may return later to pick up where you left off. When you are done, press the Complete button.



Please complete your response by .

Trustworthy	Agree	Unsure	Disagree	N/A
Demonstrates congruence between statements and actions.
Seeks to mitigate grievances by clarifying intentions and finding suitable remedies.
Consistently keeps commitments.
Is trustworthy; is someone I can trust.
Demonstrates a sense of responsibility and commitment to public trust.
Adaptability	Agree	Unsure	Disagree	N/A
Embraces change and fosters an open-minded environment.
Handles changes easily.
Willing to change ideas or perceptions based on new information or contrary evidence which is presented.
Effective in working with different personnel of the team.
Ability to recognize the potential benefits of change, and create an infrastructure which supports change.
Integrity	Agree	Unsure	Disagree	N/A
Establishes relationships of trust, honesty, fairness, and integrity.
Demonstrates sincerity in actions with others.
Accepts responsibility for mistakes.
Demonstrates honesty and truthfulness at all times.
Maintains strong relationships with others.
Management	Agree	Unsure	Disagree	N/A
Keep staff informed about what is happening in the company
Sets an example for others to follow
Is ready to offer help
Makes you feel enthusiastic about your work
Takes responsibility for things that go wrong
Initiative	Agree	Unsure	Disagree	N/A
Actively works on resolving the issue instead of procrastinating or hoping it will resolve itself.
Analyzes the needs of the situation and acts before being told to do so.
Takes charge when there is a crisis.
Will continue to work on a problem even in the face of obstacles.
Acts on own initiative to improve the department outcomes.
Technical	Agree	Unsure	Disagree	N/A
Seeks information from others as needed.
Uses expertise to identify issues and think through creative solutions to get a problem solved or objective accomplished.
Demonstrates mastery of the technical competencies required in his/her work.
Willingly shares his/her technical expertise; sought out as resource by others
Is knowledgeable of procedures or systems necessary for the job.
Interpersonal Skills	Agree	Unsure	Disagree	N/A
Pays close attention to what is being communicated verbally and nonverbally.
Strives for win/win solutions
Communicates initiatives in a clear and actionable manner to employees.
Demonstrates good communication with colleagues and customers.
Follows up on inquiries in a timely manner.
Responsible	Agree	Unsure	Disagree	N/A
Sets high personal standards of performance.
Works in a way that makes others want to work with her/him.
Completes assigned work tasks.
Is a person you can trust.
Sets a good example
Coaching	Agree	Unsure	Disagree	N/A
Coaches employees in how to strengthen knowledge and skills to improve work performance.
Addresses employee behavior problems effectively.
Meets regularly with employees to coach them on areas that will enhance their performance
Develops the skills and capabilities of others.
Conducts regular performance appraisals and feedback.
Others	Agree	Unsure	Disagree	N/A
Helpful
Includes others in the decision making processes.
...treats others with respect and dignity.
Forms working relationships with employees from other departments.
Supports the efforts of other employees in implementing solutions to problems.

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

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

    
    
52. Strengths
    
    
    
53. Areas for Development
    
    
    
54. Please give any final comments or suggestions for [Participant Name Here]'s assessment.