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Action - 360 Degree Feedback Survey Sample #1





360-Degree Feedback Survey

Questionnaires Measuring Action:
Survey 1 (4-point scale; Competency Comments)
Survey 2 (4-point scale; Competency Comments)
Survey 3 (5-point scale; Competency Comments)
Survey 4 (5-point scale; radio buttons)
Survey 5 (4-point scale; words)
Survey 6 (4-point scale; words)
Survey 7 (5-point scale; competency comments; N/A)
Survey 8 (3-point scale; Agree/Disagree words; N/A)
Survey 9 (3-point scale; Strength/Development; N/A)
Survey 10 (Comment boxes only)
Survey 11 (Single rating per competency)
Survey 12 (Slide-bar scale)
Survey 13 (4-point scale; numbers; floating anchors)
Survey 14 (4-point scale; N/A)
Instructions:

[Company] is conducting a 360-Degree Feedback Assessment developed by HR-Survey for selected managers.

You have been selected to provide feedback on the employee listed above. Your feedback is an important part of our company's leadership development process and this survey 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 questions below, think about your experiences working with this employee over the last twelve months. The effectiveness of this development tool is dependent on your honest, forthright and constructive responses so please bear this in mind as you answer each question. Your responses will be aggregated with the responses received from others and discussed with the employee to foster growth and on-going 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.

Competencies Included:
Action, Continual Learning, Leadership, Delegation, Adaptability, Juggling Multiple Responsibilities, Interpersonal Skills, Co-worker Development, Others, Entrepreneurship
Sample Result Document:
Sample Results
Your feedback is valuable in helping the individual to understand how they are perceived and experienced by others and the impact their behavior has on people in the organization with whom they interact. Feedback received also acknowledges strengths and identifies areas for development.

Use the form below to provide your feedback. Each field and comment box requires a response before you can SUBMIT your final feedback.

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
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Action

Needs
Improvement
Meets
Minimum
Standards
Is
Proficient
Role
Model
  1. Fixes small issues before they become critical incidents.
  1. Works across organizational lines and boundaries to attain goals.
  1. Decides to act rather than remain passive.
  1. Effectively makes decisions
  1. Able to get things done and make things happen.
If [Participant Name] were to make improvements in Action, what are your suggestions for how he/she can improve this?

Continual Learning

Needs
Improvement
Meets
Minimum
Standards
Is
Proficient
Role
Model
  1. Takes charge of their training and skills enhancement.
  1. Builds on their strengths while addressing their weaknesses.
  1. Seeks opportunities to grow in skills and knowledge.
  1. Shares best practices with others and learns from others.
  1. Views setbacks as opportunities to learn from.
If [Participant Name] were to make improvements in Continual Learning, what are your suggestions for how he/she can improve this?

Leadership

Needs
Improvement
Meets
Minimum
Standards
Is
Proficient
Role
Model
  1. Is a role model for ethics and integrity.
  1. Uses storytelling to make complex ideas relatable and inspire action.
  1. Provides early warning to subordinate leaders of tasks they will be responsible for.
  1. Helps employees set clear action steps to improve performance.
  1. Sets goals and objectives that exceed those of peers or team members.
If [Participant Name] were to make improvements in Leadership, what are your suggestions for how he/she can improve this?

Delegation

Needs
Improvement
Meets
Minimum
Standards
Is
Proficient
Role
Model
  1. Selects assignments that increase visibility with senior leaders or key stakeholders.
  1. Has an understanding and an awareness of how to perform tasks that are delegated to others.
  1. Empowers employees through thoughtful support, ensuring delegated work is purposeful and goal-oriented.
  1. Uses delegation to help employees explore lateral moves or pivot points in their career journey.
  1. Clearly defines tasks for employees.
If [Participant Name] were to make improvements in Delegation, what are your suggestions for how he/she can improve this?

Adaptability

Needs
Improvement
Meets
Minimum
Standards
Is
Proficient
Role
Model
  1. Adjusts strategy when new information is presented.
  1. Demonstrates willingness to change to meet the needs of the current circumstances.
  1. Develops insights and applies innovative solutions to projects and problems.
  1. Responds quickly to new information.
  1. Able to meet the needs of various stakeholders.
If [Participant Name] were to make improvements in Adaptability, what are your suggestions for how he/she can improve this?

Juggling Multiple Responsibilities

Needs
Improvement
Meets
Minimum
Standards
Is
Proficient
Role
Model
  1. Avoids bottlenecks in progress by assigning multiple individuals to critical tasks.
  1. Coordinates the work of a team by assigning tasks to other team members.
  1. Switches attention to more urgent tasks when necessary.
  1. Manages impact of increased traffic flow and freight receipt by detailed planning of controllables and by anticipating and reacting positively to uncontrollables.
  1. Completes multiple tasks simultaneously.
If [Participant Name] were to make improvements in Juggling Multiple Responsibilities, what are your suggestions for how he/she can improve this?

Interpersonal Skills

Needs
Improvement
Meets
Minimum
Standards
Is
Proficient
Role
Model
  1. Assists those in the department who need help in meeting performance metrics.
  1. Able to work with individuals at all levels of the Company.
  1. Demonstrates willingness to work with others.
  1. Uses tact, compassion, and sensitivity in interactions with others.
  1. Maintains open and regular communication with others.
If [Participant Name] were to make improvements in Interpersonal Skills, what are your suggestions for how he/she can improve this?

Co-worker Development

Needs
Improvement
Meets
Minimum
Standards
Is
Proficient
Role
Model
  1. Takes immediate action on poor performance
  1. Gives others development opportunities through project assignments and increased job responsibilities
  1. Sets and clearly communicates expectations, performance goals, and measurements to others
  1. Adapts coaching and mentoring approach to meet the style or needs of individuals
  1. Provides ongoing feedback to co-workers on their development progress
If [Participant Name] were to make improvements in Co-worker Development, what are your suggestions for how he/she can improve this?

Others

Needs
Improvement
Meets
Minimum
Standards
Is
Proficient
Role
Model
  1. Constructively receives criticism and suggestions from others.
  1. Forms working relationships with employees from other departments.
  1. Works across boundaries within the organization.
  1. Helpful
  1. Works effectively with people from other departments.
If [Participant Name] were to make improvements in Others, what are your suggestions for how he/she can improve this?

Entrepreneurship

Needs
Improvement
Meets
Minimum
Standards
Is
Proficient
Role
Model
  1. Takes the initiative to complete tasks.
  1. Is comfortable operating in an environment of uncertainty.
  1. Able to adapt the department to changing business demands and climate.
  1. Seeks and utilizes mentors to help guide professional development.
  1. Understands the processes and various stages of business development.
If [Participant Name] were to make improvements in Entrepreneurship, what are your suggestions for how he/she can improve this?

  1. What are [Participant Name Here]'s greatest strengths demonstrated this year?


  2. What are [Participant Name Here]'s areas for development?


  3. Please give any final comments or suggestions for [Participant Name Here]'s assessment.