Empowering Others - 360 Degree Feedback Survey Sample #12

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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Empowering Others

• Values the expertise that others bring to the team.
• Recognizes the accomplishments of employees when they complete important assignments.
• Creates a culture where employees are given the opportunity to take the initiative and make impactful decisions.
• Helps employees advance their skills so that they can have more autonomy.
• Gives responsibility for making important decisions to employees.

Needs Improvement		Fully Proficient		Excels/ Role Model
Click this box to make your rating

Comments:

Decision Making

• Considers the ethical implications of decisions.
• Builds decisions with contingency plans and modular thinking to accommodate future change.
• Seeks input from key people who should be involved in, or will be affected by, decisions
• Anticipates impacts that may not be immediately obvious, reducing risk exposure.
• Makes decisions independently (without having to be told what or how).

Needs Improvement		Fully Proficient		Excels/ Role Model
Click this box to make your rating

Comments:

Juggling Multiple Responsibilities

• Avoids bottlenecks in progress by assigning multiple individuals to critical tasks.
• Assigns tasks based on skills of team members.
• Prioritizes tasks for efficiency.
• Determines which tasks are critical and which tasks are optional.
• Is aware of the deadlines for specific tasks/assignments.

Needs Improvement		Fully Proficient		Excels/ Role Model
Click this box to make your rating

Comments:

Organizational Fluency

• Anticipates problems that may affect the department.
• Effective in communicating with others within the organization.
• Understands departmental policies and procedures.
• Able to explain departmental policies and procedures to others.
• Understands the current organizational culture.

Needs Improvement		Fully Proficient		Excels/ Role Model
Click this box to make your rating

Comments:

Cultural Awareness

• May advocate for others with different cultural backgrounds.
• Builds collaborative relationships by honoring cultural norms and interpersonal boundaries.
• Fosters a diverse workforce free from discrimination and harassment.
• Tailors solutions to accommodate diverse cultural needs and expectations.
• Avoids referring to stereotypes about others from different cultures.

Needs Improvement		Fully Proficient		Excels/ Role Model
Click this box to make your rating

Comments:

Strengths


Areas for Development


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