360 Degree Feedback Survey

You have been asked to evaluate ______ as part of a 360-degree feedback process. Other employees, including your supervisors and peers, will also evaluate ________. In this manner, ________ will be provided with a comprehensive, multi-perspective (i.e., 360-degree) view of his/her performance. The objective is to provide feedback so as to allow ________ to improve his/her performance, resulting in improved team performance, and organizational effectiveness. If you are unsure of a response, please select N/A.

Your responses are confidential.

They will be blended with several other employees' opinions.

Read the statements below and indicate how frequently does ____________ exhibit the following ...


Rarely Once in a While Sometimes Fairly
Very Frequently N/A
  1. Conveys strong sense of own pride in the company.
  1. Creates a sense of urgency among the team members to complete activities.
  1. Is accessible and approachable.
  1. Is motivated by the desire to be "the best".
  1. Maintains self-confidence and a positive mental attitude while facing challenging peaks and valleys of activities.
  1. Open to constructive criticism and responds positively to instructions and procedures.
  1. Sets an example for others during stressful periods by maintaining a positive, can-do attitude.


Rarely Once in a While Sometimes Fairly
Very Frequently N/A
  1. Constantly enhances product knowledge through experimentation and research.
  1. Constructively challenges established processes to improve company productivity and quality.
  1. Creates innovative methods of developing others and improving sales.
  1. Looks beyond company for new ideas and innovative approaches.
  1. Uses own and others' knowledge and experience to create new ways of doing routine activities.

Ability to Adapt to Change

Rarely Once in a While Sometimes Fairly
Very Frequently N/A
  1. Analyzes own reactions on the spot to ensure that communication does not appear to be driven by anger.
  1. Anticipates potential challenges, develops plan to overcome them and then carries out the plan.
  1. Creates back-up plan.
  1. Recognizes own areas for development and consciously seeks assignments that will provide practice in areas of developmental need.
  1. Responds quickly to customer problems and needs.


Rarely Once in a While Sometimes Fairly
Very Frequently N/A
  1. Follows established policies and procedures.
  1. Holds self and others accountable for goal achievement.
  1. Makes sound decisions, based on facts rather than emotion.
  1. Persists until goals are achieved and commitments are met.
  1. Plans and organizes continuously while performing all other responsibilities and activities.
  1. Shows confidence to manage most circumstances within area of authority.
  1. Takes initiative and demonstrates commitment to the job and organization.
  1. Willing to do whatever it takes-not afraid to have to put in extra effort.
  1. Work is of high quality and free from errors and mistakes.

Knowledge of Business

Rarely Once in a While Sometimes Fairly
Very Frequently N/A
  1. Accomplishes major tasks by breaking them into manageable pieces.
  1. Analyzes normal procedures and identifies opportunities for improvement.
  1. Demonstrates competence in required job skills & knowledge; keeps skills up-to-date.
  1. Demonstrates knowledge and understands the company's products, policies and procedures.

Ability to Build Coalitions

Rarely Once in a While Sometimes Fairly
Very Frequently N/A
  1. Develops systematic approach to get resources needed to accomplish the goal.
  1. Interacts productively with me in formal/informal groups within and outside their department.
  1. Seeks out best practice methods within and outside the Company to create continuous improvement in performance.
  1. Visits other departments to capture ideas and inspirations and make networking contacts.

Ability to Teach Others

Rarely Once in a While Sometimes Fairly
Very Frequently N/A
  1. Assesses others' developmental needs by asking questions about what they know and what they like to do.
  1. Demonstrates commitment to long-term development of self and co-workers.
  1. Encourages co-workers through recognition of positive changes in behavior.
  1. Encourages others to accomplish tasks or projects by helping them break projects down into manageable pieces.
  1. Encourages others to question certain procedures which they may not understand and to communicate what they need.

Personal Style

Rarely Once in a While Sometimes Fairly
Very Frequently N/A
  1. Actively seeks to learn by asking questions and listening to others.
  1. Analyzes interpersonal problems instead of reacting to them.
  1. Bounces back from daily crisis, disappointments and frustrations.
  1. Consciously controls own negative emotions in order to keep team morale up.
  1. Critiques own performance and learns from experience as a source of continuous improvement.
  1. Deals with conflict by controlling own emotions by listening, being flexible, and sincere in responding.
  1. Demonstrates through personal behavior the commitment to high standards of performance.
  1. Does not allow own emotions to interfere with the performance of others.
  1. Does not blame others or make excuses but rather helps define solutions and/or resolutions to problems.
  1. Is aware of personal impact on others and adjusts behavior to create a positive leadership presence.
  1. Steps away from a situation to process appropriate response.
  1. Takes initiative for own learning and development.
  1. Uses patience and self-control in working with others.


Rarely Once in a While Sometimes Fairly
Very Frequently N/A
  1. Actively works to ensure that the customer has a satisfying experience.
  1. Acts in an empowered way to handle customer service issues.
  1. Asks questions and listens carefully to determine customer needs and to ensure that the customer's needs are met.
  1. Clearly explains performance expectations and goals to be reached at the beginning of a project, then allows others decide how to achieve the goal.
  1. Stays focused by seeing all aspects of the situation through the customers' eyes.
  1. Writes documents and verbally communicates clearly, concisely and effectively.

Willingness to work with peers

Rarely Once in a While Sometimes Fairly
Very Frequently N/A
  1. Consistently communicates why something needs to be done or changed and relates current initiatives to Company vision and goals.
  1. Coordinates all activities into a cohesive team effort.
  1. Develops effective solutions for viewing problems from a different point of view.
  1. Develops others' strengths by encouraging them.
  1. Identifies and shares information which is useful to self and others to promote prompt response to business needs.
  1. Pays attention to and conveys understanding of the comments and questions of others.
  1. Recognizes and celebrates teams' accomplishments, contributions and successes.
  1. Seeks input and ideas from coworkers by asking them questions and involving them.
  1. Shares innovations with other managers, peers, supervisors, and Home Office.
  1. Values upward feedback from peers and solicits it actively.


Opportunities for Development:

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