Rater:

You are providing feedback to:

Instructions

You have been selected to provide feedback for the manager listed above. Your feedback is an important part of our company'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 twelve months. Your responses will be merged with other's feedback and presented to to guide them in their on-going development. Comments will be shared anonymously as written with the manager, unless you indicate otherwise.

Method of use: As part of the annual appraisal process, leaders receive feedback from peers, subordinates, customers and supervisors. 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 individual's annual appraisal and development plan.

How do you feel exhibits the following ...

Interpersonal Every aspect of the survey can be customized including items and response alternatives.	Clear Strength	Capable and Effective Performance	Could Benefit from Development	Needs Significant Improvement	N/A Not Observed
Treats employees with respect.
Behaves in a fair and trustworthy manner.
Handles tough employee issues fairly and effectively; works well to resolve conflicts.
Handles job-related stress effectively (does not blame others, become hostile or overly moody); keeps in control of his/her feelings and behavior.
Keeps employees informed of information they need to do their jobs.
Leadership	Clear Strength	Capable and Effective Performance	Could Benefit from Development	Needs Significant Improvement	N/A Not Observed
Understands employees needs.
Provides the necessary training, guidance, and motivation to help employees meet and exceed their job responsibilities.
Creates an open and trusting environment where people feel safe to discuss concerns, ideas, opinions.
Provides appropriate recognition to employees for good performance.
Sets and communicates clear performance expectations.
Results Orientation/Leading Change	Clear Strength	Capable and Effective Performance	Could Benefit from Development	Needs Significant Improvement	N/A Not Observed
Embraces safety procedures and makes employees accountable for working within safety policies; reports injuries and near-miss situations per policy; takes immediate action when unsafe acts are observed.
Holds all employees accountable for their results.
Is positive and passionate about the Company and its mission.
Makes timely, well-informed decisions; thinks through the impact and implications of decisions.

Questionnaires can be of any length from a few items to over a hundred items. Longer questionnaires take more time to complete.

Note: When you enter text comments into the boxes below, please focus your comments on work behaviors and styles. The comments that you type will be viewed by the individual receiving the feedback. Do not enter personal information about yourself unless you want this individual to know you are the author of these comments.
In the spaces provided below, please type in any comments/feedback about that you believe are relevant to their development.

General Comments:

Greatest Improvement Needed: 1. 2. 3.	Suggestion for Development 1. 2. 3.
Text Boxes can include pre-defined prompts to encourage detailed responses. What three characteristics of do you ADMIRE MOST? 1. 2. 3.