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Empowering Others- 360 Degree Feedback Survey Sample #1





360-Degree Feedback Survey

Questionnaires Measuring Empowering Others:
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:
Empowering Others, Excellence, Integrity, Professional Development, Administrative Skill, Innovation, Commitment To Result, Safety, Trustworthy, Planning
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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Empowering Others

Needs
Improvement
Meets
Minimum
Standards
Is
Proficient
Role
Model
  1. Lets employees complete tasks according to their methods.
  1. Allows employees to take ownership of their work.
  1. Includes others in the decision making process.
  1. Enables team members to make their own decisions on the project.
  1. Values the input from others.
If [Participant Name] were to make improvements in Empowering Others, what are your suggestions for how he/she can improve this?

Excellence

Needs
Improvement
Meets
Minimum
Standards
Is
Proficient
Role
Model
  1. Can be counted on to add value wherever they are involved.
  1. Demonstrates the analytical skills to do their job.
  1. Produces high quality work.
  1. Is planful and organized.
  1. Takes a lot of pride in their work.
If [Participant Name] were to make improvements in Excellence, what are your suggestions for how he/she can improve this?

Integrity

Needs
Improvement
Meets
Minimum
Standards
Is
Proficient
Role
Model
  1. Is consistent in ethical behavior, demonstrating professionalism and a commitment to the company's values.
  1. Always exhibits a high standard of ethics and integrity
  1. Does the right thing even when negative consequence may result.
  1. Pays attention to the "little things" to help maintain a positive reputation.
  1. Willing to issue product recalls if necessary.
If [Participant Name] were to make improvements in Integrity, what are your suggestions for how he/she can improve this?

Professional Development

Needs
Improvement
Meets
Minimum
Standards
Is
Proficient
Role
Model
  1. Demonstrate enthusiasm and a willingness to learn new skills and knowledge
  1. Contributing fully to the extent of their skills
  1. Allows employees to fully participate in employee training and professional development.
  1. Seeks opportunities for continuous learning.
  1. Keep themselves up-to-date of technical/professional issues
If [Participant Name] were to make improvements in Professional Development, what are your suggestions for how he/she can improve this?

Administrative Skill

Needs
Improvement
Meets
Minimum
Standards
Is
Proficient
Role
Model
  1. Processes payroll information.
  1. Displays a professional presence when interacting with others.
  1. Books travel arrangements by purchasing tickets for transportation and securing accommodations.
  1. Maintains a clear and positive tone when speaking avoiding mumbling or use of slang terms.
  1. Implements and uses performance measures.
If [Participant Name] were to make improvements in Administrative Skill, what are your suggestions for how he/she can improve this?

Innovation

Needs
Improvement
Meets
Minimum
Standards
Is
Proficient
Role
Model
  1. Challenges current procedures / processes to develop new solutions.
  1. Utilizes disruptive innovation to help managers transform conventional business models, making products and services more accessible and affordable.
  1. Explores new ways of doing things.
  1. Creates a safe environment for idea-sharing.
  1. Creates new programs and systems.
If [Participant Name] were to make improvements in Innovation, what are your suggestions for how he/she can improve this?

Commitment To Result

Needs
Improvement
Meets
Minimum
Standards
Is
Proficient
Role
Model
  1. Able to focus on a task even when working alone.
  1. Maintains persistence and dedication to achieving results.
  1. Willing to do whatever it takes-not afraid to have to put in extra effort.
  1. Takes immediate action toward goals.
  1. Encourages commitment in others to obtain results.
If [Participant Name] were to make improvements in Commitment To Result, what are your suggestions for how he/she can improve this?

Safety

Needs
Improvement
Meets
Minimum
Standards
Is
Proficient
Role
Model
  1. Is not afraid to question a potential safety issue observed in the workplace.
  1. Identifies and addresses safety needs.
  1. Encourages others to attend safety training.
  1. Supports our company's safety programs.
  1. Works to implement corrective safety measures.
If [Participant Name] were to make improvements in Safety, what are your suggestions for how he/she can improve this?

Trustworthy

Needs
Improvement
Meets
Minimum
Standards
Is
Proficient
Role
Model
  1. Is trustworthy; is someone I can trust.
  1. Builds and maintains the trust of others.
  1. Communicates an understanding of the other person's interests, needs and concerns.
  1. Seeks to mitigate grievances by clarifying intentions and finding suitable remedies.
  1. Takes ownership, delivers on commitments
If [Participant Name] were to make improvements in Trustworthy, what are your suggestions for how he/she can improve this?

Planning

Needs
Improvement
Meets
Minimum
Standards
Is
Proficient
Role
Model
  1. Makes plans and follows through.
  1. Closely follows the plan established for the department.
  1. Determines what supplies/equipment will be needed for the job.
  1. Makes strategic and tactical decisions to guide the logistics process.
  1. Creates effective project plans.
If [Participant Name] were to make improvements in Planning, 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.