Vision- 360 Degree Feedback Survey Sample #5

360-Degree Assessment Survey

Dear Employee:

Thank you for participating in a 360-degree feedback assessment. In this process, you will complete a self-assessment questionnaire (below). You will also receive feedback from others including your manager, peers and direct reports. As you respond, please respond using just your experiences in the past 12 months. Rate each item using the scale shown. 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 you at the conclusion of this assessment to help guide your ongoing professional 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

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Vision	Role Model	Capable and Effective	Somewhat Effective	Needs Development
You develop a vision to inspire collective action.
I am aware of my own actions and how that impacts the department.
I establish the direction and strategy for the organization.
I stay ahead of the curve to guide my team towards innovative solutions and strategic decisions.
You pinpoint challenges and devises strategies.
Strategic Focus	Role Model	Capable and Effective	Somewhat Effective	Needs Development
You exhibit a strategic orientation to identify and capitalize on opportunities to advance the organization.
You understand and contribute to development of strategic goals.
I make sure that all departments/teams are contributing toward the success of the strategy.
You ensure that the department's goals are strategically aligned with the company's goals.
You let employees know how their roles contribute toward the achievement of strategic company objectives.
Accountability	Role Model	Capable and Effective	Somewhat Effective	Needs Development
You are someone who is trustworthy.
You are personally invested in the success of the organization.
You fully embrace the responsibilities that contribute to our departmental success.
I take full responsibility for results.
You can be counted on to do what you say you are going to do.
Continual Improvement	Role Model	Capable and Effective	Somewhat Effective	Needs Development
You encourage an employee culture of continuous improvement to seek out better ways of doing things.
You look for ways to improve work processes and procedures.
You analyze processes to determine areas for improvement.
You are open to the suggestions from others.
You search for new methods, techniques, and processes that increase efficiency and reduce costs.
Administrative Skill	Role Model	Capable and Effective	Somewhat Effective	Needs Development
You complete reports on-time.
You have strong organizational skills to keep the workspace and department in order
You implement and use performance measures.
You have a high attention to detail.
You take responsibility for decisions.
Safety	Role Model	Capable and Effective	Somewhat Effective	Needs Development
You encourage others to work safely.
You work to implement corrective safety measures.
You keep accurate safety records.
You develop safety guidelines for the department.
You develop a strong safety culture.
Developing Others	Role Model	Capable and Effective	Somewhat Effective	Needs Development
You support the successes of other employees.
You set performance objectives for subordinates that encourages development opportunities.
You are open to receiving feedback.
You try to ensure employees are ready to move to the next level.
You encourage employees through recognition of positive changes in behavior.
Coaching	Role Model	Capable and Effective	Somewhat Effective	Needs Development
You provide clear, motivating, and constructive feedback.
You meet regularly with employees to coach them on areas that will enhance your performance
You help employees to understand responsibilities, authority, and expectations.
You help employees to maintain high personal standards.
You address employee behavior problems effectively.

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.