Communication - 360 Degree Feedback Survey Sample #4

Dear Employee:

Welcome to our 360-Degree Feedback self-assessment questionnaire. Our objective is to provide feedback which will help advance your leadership skills and capabilities. We are asking you to take time to respond to this survey to help us identify areas where you are doing well and where you have opportunities to do better. Others will also complete the questionnaire to provide you with feedback.

We have developed this survey with questions tailored for your position in the department to provide you with an opportunity to rate many facets of your leadership performance.

Please be honest, constructive and thoughtful in your responses. The results of this survey will be used to help drive our future success. If you have any questions about the process please contact [Contact Person].

Please ensure that your submission is made between . The survey will only be available during these dates.

Thank you for your participation in the survey. We look forward to seeing the analysis of your responses and we are hoping for 100% participation.

Management Team

Instructions:
Please complete the items below and press the submit button at the end of the survey. If you need multiple sessions to complete the survey, please click the "Submit" button at the end of each session to save your responses. Please feel free to skip any items that you do not wish to respond to. Keep in mind that your responses help us to become a better place to work. So, you are encouraged to respond to all items on the questionnaire.

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Communication Skills	Needs Significant Development 1	2	Capable and Effective 3	4	Role Model 5
You ask follow-up questions as needed.
You are an effective communicator
You deal with difficult situations calmly and confidently.
You choose the communication medium (ie. email, voice mail, memo, project document) that reflects the needs of the content. (ie. urgency, confidentiality, content scope)
You are able to demonstrate persuasiveness in pursuit of objectives.
Adaptability	Needs Significant Development 1	2	Capable and Effective 3	4	Role Model 5
You are flexible and open to new ideas and encourages others to value change.
You are able to work effectively with new people and new teams.
You adjust priorities to changing business goals.
You are willing to change ideas or perceptions based on new information or contrary evidence which is presented.
You perform a wide range of tasks, respond to changes in direction and priorities and accept new challenges, responsibilities, and assignments.
Cultural Awareness	Needs Significant Development 1	2	Capable and Effective 3	4	Role Model 5
You foster a diverse workforce free from discrimination and harassment.
You seek out different viewpoints and benefits from different perspectives.
You respect others regardless of age, race, gender, nationality, or disability.
You encourage a work environment where individual differences are valued.
You maintain an inclusive work environment that maximizes the talents of others in achieving goals.
Leadership	Needs Significant Development 1	2	Capable and Effective 3	4	Role Model 5
You are a highly effective supervisor.
You give direct, constructive, and actionable feedback.
You motivate others to reach and exceed organizational goals and objectives.
You clearly explain performance expectations and goals to be reached at the beginning of a project, then let others decide how to achieve the goal.
You are able to align manpower, design work, an allocate tasks to achieve goals.
Delegation	Needs Significant Development 1	2	Capable and Effective 3	4	Role Model 5
You allow employees to decide how they wish to complete the tasks.
You delegate authority and responsibility to subordinates and holds them accountable for your actions.
You delegate tasks, responsibilities, and accountability as appropriate to the level of employee.
You define the roles, responsibilities, required actions, and deadlines for team members.
You define goals and objectives for subordinates.
Innovation	Needs Significant Development 1	2	Capable and Effective 3	4	Role Model 5
You find creative ways to get things done with limited resources.
You challenge current procedures to develop other alternatives.
You create a safe environment for idea-sharing.
You analyze current procedures and identify opportunities for improvement.
You offer constructive improvements to existing systems.
Results Oriented	Needs Significant Development 1	2	Capable and Effective 3	4	Role Model 5
You work toward achievement of goals even when confronted with obstacles.
You provide clear expectations for employees.
You help others when free-time is available.
You demonstrate the personal confidence to "stay the course," even when faced with difficulty
You encourage a high-energy, fun work environment and coaches others on how to do the same
Safety	Needs Significant Development 1	2	Capable and Effective 3	4	Role Model 5
You are not afraid to question a potential safety issue observed in the workplace.
You mitigate hazards and safety issues that arise.
You participate in safety training when offered.
You identify predictable hazards in the workplace.
You participate in safety training as applicable.
Responsible	Needs Significant Development 1	2	Capable and Effective 3	4	Role Model 5
Your behavior is ethical and honest.
You set high personal standards of performance.
You hold yourself accountable to goals / objectives
You complete assigned work tasks.
You take personal responsibility for results.
Regulatory/Compliance	Needs Significant Development 1	2	Capable and Effective 3	4	Role Model 5
You follow all safety regulations and procedures.
You work quickly to implement changes in regulations.
You offer training to employees to ensure they are complying with regulations.
You interact with auditors and regulators on a professional basis.
You perform audits regularly, or without notice, to ensure proper compliance with regulations.

51. On a scale of Excellent to Poor, how would you rate your overall employment with [Company] and why?
    

    -Excellent -Good -Average -Poor




52. Would you refer others who are seeking employment to [Company]?
    Yes No
    
    Please provide explanation:
    
    


53. If you had an opportunity to make any change you wanted to make [Company] a better place to work, what one improvement would you make?
    
    
    


54. What changes do you see [Company] making in order to raise the standards?
    
    


55. I feel good about my continued employment with [Company].
    Yes No
    
    If no, please provide explanation:
    
    
    


56. What do you like best about working for [Company]?
    
    


57. What do you like least about working for [Company]? How could it be improved?
    


93. Use the space below to enter any final comments you would like to be noted: