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
Communicates an understanding of the other person's interests, needs and concerns.
Takes ownership, delivers on commitments
Demonstrates congruence between statements and actions.
Builds and maintains the trust of others.
Takes care to maintain confidential information.
Adaptability	Agree	Unsure	Disagree	N/A
Able to step in and help co-workers when needed.
Works effectively with various personalities of team members.
Develops insights and applies innovative solutions to projects and problems.
Is open to changes in policies and procedures.
Adjusts to the new vision and mission of the company.
Integrity	Agree	Unsure	Disagree	N/A
Develops trust and confidence from others.
Fosters an environment built upon trust.
Establishes relationships of trust, honesty, fairness, and integrity.
Fosters a high standard of ethics and integrity.
Accepts responsibility for mistakes.
Management	Agree	Unsure	Disagree	N/A
Is ready to offer help
Makes you feel enthusiastic about your work
Delegate tasks effectively
Takes responsibility for things that go wrong
Sets an example for others to follow
Initiative	Agree	Unsure	Disagree	N/A
Anticipates problems and initiates plans to address them.
Builds strong interpersonal relationships upon first meeting.
Takes corrective action to address performance deficiencies/issues.
Engages with new customers immediately.
Acts with urgency when time is limited.
Technical	Agree	Unsure	Disagree	N/A
Willingly shares his/her technical expertise; sought out as resource by others
Seeks information from others as needed.
Uses expertise to identify issues and think through creative solutions to get a problem solved or objective accomplished.
Is knowledgeable of procedures or systems necessary for the job.
Willingly shares information and expertise; sought out as resource by others
Interpersonal Skills	Agree	Unsure	Disagree	N/A
Communicates initiatives in a clear and actionable manner to employees.
Applies appropriate communication techniques to the situation.
Is honest about making mistakes and willing to fix them.
Builds strong relationships with team members.
Demonstrates a high degree of ethics and integrity in the workplace.
Responsible	Agree	Unsure	Disagree	N/A
Sets a good example.
Behavior is ethical and honest.
Acts as a resource without removing individual responsibility.
Holds herself / himself accountable to goals / objectives
Works in a way that makes others want to work with her/him.
Coaching	Agree	Unsure	Disagree	N/A
Provides clear, motivating, and constructive feedback.
Meets regularly with employees to coach them on areas that will enhance their performance
Conducts regular performance appraisals and feedback.
Develops the skills and capabilities of others.
Coaches employees in how to strengthen knowledge and skills to improve work performance.
Others	Agree	Unsure	Disagree	N/A
Forms working relationships with employees from other departments.
Works across boundaries within the organization.
Constructively receives criticism and suggestions from others.
Respects the opinions of other employees.
Treats others with respect and dignity.

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.