Action - 360 Degree Feedback Survey Sample #11

360 Feedback Survey

Instructions

We appreciate you taking the time to provide valuable feedback for the individual mentioned above. As you respond, please draw on your first-hand experience with this individual in the past 12 months. Your insights are crucial in offering a comprehensive evaluation. Please rate each item using the scale provided. If you find that you do not have sufficient first-hand knowledge to rate a particular item, select the Not Applicable option.

In addition to the ratings, we encourage you to include comments where possible. These comments are particularly useful when you give a very high or very low rating, as they provide context and clarity regarding your assessment. Explaining your reasons in the comment section helps ensure that your feedback is constructive and actionable.

Your responses, combined with feedback from other contributors, will be compiled and presented to the individual. This collective feedback aims to support their continuous growth and development by highlighting strengths and identifying areas for improvement. Your thoughtful participation is essential in helping them achieve their full potential.

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.

To what extent does [Participant Name] exhibit the following ...

SELECT the rating that best reflects the employee's performance in the areas listed.

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Action

What does Action mean?
It means that ...

• I do not procrastinate when there is a job to be done.
• I create performance measures to ensure action by the department.
• You regularly conduct preventative maintenance on the equipment.
• I am ambitious when working on the project.
• You address safety issues immediately.

To what extent does this person exhibit Action?
Select from one of the ratings below.

Not Applicable or Unable to Judge

Poor does not perform to expected standards; often unable to complete tasks; does not seek help or advice

Minimal completes tasks only when pressured to do so; is satisfied with minimal progress; only does what is required

Average completes tasks easily; seeks to obtain maximal performance; willing to seek advice and help when needed

Role Model is a role model for others to follow; goes above and beyond what is expected; helps others

Self Management

What does Self Management mean?
It means that ...

• You analyze own reactions on the spot to ensure that communication does not appear to be driven by anger.
• You use patience and self-control in working with customers and associates.
• You analyze interpersonal problems instead of reacting to them.
• You consciously control own negative emotions in order to keep team morale up.
• You are aware of personal impact on others and adjusts behavior to create a positive leadership presence.

To what extent does this person exhibit Self Management?
Select from one of the ratings below.

Not Applicable or Unable to Judge

Poor does not perform to expected standards; often unable to complete tasks; does not seek help or advice

Minimal completes tasks only when pressured to do so; is satisfied with minimal progress; only does what is required

Average completes tasks easily; seeks to obtain maximal performance; willing to seek advice and help when needed

Role Model is a role model for others to follow; goes above and beyond what is expected; helps others

Performance

What does Performance mean?
It means that ...

• You are effective in performing your job.
• You work effectively in the department.
• You produce quality
• You are able to organize work.
• You have great overall performance

To what extent does this person exhibit Performance?
Select from one of the ratings below.

Not Applicable or Unable to Judge

Poor does not perform to expected standards; often unable to complete tasks; does not seek help or advice

Minimal completes tasks only when pressured to do so; is satisfied with minimal progress; only does what is required

Average completes tasks easily; seeks to obtain maximal performance; willing to seek advice and help when needed

Role Model is a role model for others to follow; goes above and beyond what is expected; helps others

Time Management

What does Time Management mean?
It means that ...

• You usually work with a sense of urgency.
• I take the initiative to tackle critical issues earlier rather than later.
• You prioritize new tasks according to your relative importance.
• I allow for time buffers between tasks so that the schedule does not become delayed due to unforeseen circumstances.
• You complete tasks ahead of schedule.

To what extent does this person exhibit Time Management?
Select from one of the ratings below.

Not Applicable or Unable to Judge

Poor does not perform to expected standards; often unable to complete tasks; does not seek help or advice

Minimal completes tasks only when pressured to do so; is satisfied with minimal progress; only does what is required

Average completes tasks easily; seeks to obtain maximal performance; willing to seek advice and help when needed

Role Model is a role model for others to follow; goes above and beyond what is expected; helps others

Developing Others

What does Developing Others mean?
It means that ...

• You support the successes of other employees.
• You encourage employees through recognition of positive changes in behavior.
• You try to ensure employees are ready to move to the next level.
• You are open to receiving feedback.
• You assign tasks and responsibilities to develop skills of others.

To what extent does this person exhibit Developing Others?
Select from one of the ratings below.

Not Applicable or Unable to Judge

Poor does not perform to expected standards; often unable to complete tasks; does not seek help or advice

Minimal completes tasks only when pressured to do so; is satisfied with minimal progress; only does what is required

Average completes tasks easily; seeks to obtain maximal performance; willing to seek advice and help when needed

Role Model is a role model for others to follow; goes above and beyond what is expected; helps others

Organizational Fluency

What does Organizational Fluency mean?
It means that ...

• You anticipate problems that may affect the department.
• You are aware of other organizational cultures to compare/contrast with the current organizational culture.
• You understand the current organizational culture.
• You are effective in communicating with others within the organization.
• You understand departmental policies and procedures.

To what extent does this person exhibit Organizational Fluency?
Select from one of the ratings below.

Not Applicable or Unable to Judge

Poor does not perform to expected standards; often unable to complete tasks; does not seek help or advice

Minimal completes tasks only when pressured to do so; is satisfied with minimal progress; only does what is required

Average completes tasks easily; seeks to obtain maximal performance; willing to seek advice and help when needed

Role Model is a role model for others to follow; goes above and beyond what is expected; helps others

Strengths


Areas for Development


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