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360 Feedback Survey Sample 14

This example questionnaire shows how comments can be an integral part of the survey. In this example, a comment box is provided for each rating made by the participant. These written comments provide valuable feedback in more detail than just a single rating.


ABC Global 360-Degree Feedback


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 '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 the manager 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.

Performance Rating Guide:

  • Excels/Role model. Results consistently exceed expectations. Makes significant contributions well beyond requirements. Outpaces the majority of peers.
  • Fully Proficient. Results are fully and consistently on target. Makes a valuable contribution. Is fully competent. This level describes performance of the majority of employees.
  • Developing/Usually meets standards. Results are usually on target. May need occasional support. Still learning how to perform responsibilities independently.
  • Needs improvement. Improvement clearly needed. Is consistent in performance and requires excessive supervision and support. An action plan for improvement in this area needed.
Your questionnaire can be customized to include competencies and items relevant for your needs. Competencies and items can vary depending on job classification or other demographic factors.

To what extent does ____________ exhibit the following ...

Problem Solving
  • Able to develop innovative solutions to problems.
  • Identifies and assesses all potential responses to a problem.
  • Asks the "right" questions to size up or evaluate situations.
  • Actively seeks the root cause of a problem.
Excels/Role Model

Fully Proficient

Developing/
____Usually meets standards

Needs Improvement

Comments:


You can specify which completencies are included. For a more customized solution, the competencies can vary by job class or level.
Teamwork
  • Actively participates as a team member
  • Creates a culture that fosters and values collaboration.
  • Fosters teamwork rather than individual competition.
  • Seeks and listens to otherís contributions
Excels/Role Model

Fully Proficient

Developing/
____Usually meets standards

Needs Improvement

Comments:


You can specify which definitions and behavioral statements that accompany each completency. These can vary by job class or level.
Bias for Action
  • Follows-up and takes action when goals are not met to ensure better results in the future.
  • Set high standards in their performance.
  • Accomplishes goals on schedule and under budget.
  • Demonstrates a well-organized and timely approach to achieve desired results.
Excels/Role Model

Fully Proficient

Developing/
____Usually meets standards

Needs Improvement

Comments:


Leadership
  • Is a leader within the department.
  • Improves work quality for the team.
  • Motivates others to reach and exceed organizational goals and objectives.
  • Influences the decisions made.
Excels/Role Model

Fully Proficient

Developing/
____Usually meets standards

Needs Improvement

Comments:


Responsible
  • Behavior is ethical and honest.
  • Sets a good example for others.
  • Works in a way that makes others want to work with her/him.
  • Takes personal responsibility for results.
Excels/Role Model

Fully Proficient

Developing/
____Usually meets standards

Needs Improvement

Comments:


Decision Making
  • Asks for additional information when making critical decisions, rather than operate blindly.
  • Does not lose sight of the big picture when making decisions.
  • Understands the issues, problems, and potential solutions.
  • Remains calm when making important or difficult decisions.
  • Prepares for potential problems and opportunities in working toward desired goals.
Excels/Role Model

Fully Proficient

Developing/
____Usually meets standards

Needs Improvement

Comments:


Interpersonal Skills
  • Adapts management style to meet the needs of the individual or situation.
  • Gives honest feedback and suggestions for improvement.
  • Values the opinions of others.
  • Establishes good raport with employees and customers.
Excels/Role Model

Fully Proficient

Developing/
____Usually meets standards

Needs Improvement

Comments:


Planning
  • Able to look ahead (beyond the present) when addressing the work/needs of the department.
  • Identifies resources needed to accomplish objectives.
  • Regularly plans and participates in networking and recruiting activities to ensure additional help is available throughout the year.
  • Sets up and monitors timeframes and plans.
Excels/Role Model

Fully Proficient

Developing/
____Usually meets standards

Needs Improvement

Comments:


Additional follow-up items are provided to allow the participant to provide feedback not specifically requested in some other part of the form.

Please provide additional comments in the box below on this individualís overall performance as it relates to their job responsibilities. Examples of specific behaviors and situations are helpful.

Describe ____________ís commitment to customer service excellence and quality. Specific examples to support observations are helpful:



The computer will automatically insert the name of the participant in the items where currently a horizontal bar is shown.
Please provide any additional comments on what you value or appreciate most about ____________'s leadership effectiveness, style or behaviors:



What would you suggest to ____________ as areas for focus and development: