Trustworthy - 360 Degree Feedback Survey Sample #12

360 Feedback Survey

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.

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.

Trustworthy

• Demonstrates a sense of responsibility and commitment to public trust.
• Seeks to mitigate grievances by clarifying intentions and finding suitable remedies.
• Is trustworthy; is someone I can trust.
• Is a person you can trust.
• Demonstrates congruence between statements and actions.

Needs Improvement		Fully Proficient		Excels/ Role Model
Click this box to make your rating

Comments:

Leadership

• Highly effective supervisor.
• Gives direct, constructive, and actionable feedback.
• Takes ownership and accountability for results
• Acts decisively in implementing decisions.
• Able to influence others.

Needs Improvement		Fully Proficient		Excels/ Role Model
Click this box to make your rating

Comments:

Problem Solving

• Identifies and assesses all potential responses to a problem.
• Able to balance the needs of different people in a solution to a problem.
• Is a good problem solver and decision maker
• Works cooperatively with others to solve problems.
• Ability to develop innovative solutions to problems.

Needs Improvement		Fully Proficient		Excels/ Role Model
Click this box to make your rating

Comments:

Results Oriented

• Directs team in prioritizing daily work activities
• Explains the "whys" behind organizational objectives
• Helps others when free-time is available.
• Demonstrates the personal confidence to "stay the course," even when faced with difficulty
• Provides clear expectations for employees.

Needs Improvement		Fully Proficient		Excels/ Role Model
Click this box to make your rating

Comments:

Empowering Others

• Distributes the workload to subordinates.
• Encourages employees to solve problems on their own.
• Provides support and resources needed to accomplish goals.
• Sets clear goals for others to accomplish.
• Encourages others to obtain necessary skills and training.

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.