360 Degree Feedback Example

360 Degree Feedback Example

360 Degree Feedback Example

Management, Administrative, and Professional Employee 360° Performance Evaluation

Date:  
To:
 
From:
 

 

A performance assessment is being prepared for the employee named below.  You have been identified as an individual who frequently interacts with this employee in the course of his/her work.  Please take a few minutes to complete this form, providing constructive, work-focused input on his/her job performance.  Comments which reference specific work or observed traits, skills or behaviors are most helpful, rather than general characterizations.  If you would prefer to discuss your input either in person or by phone, please contact me.

A 360° evaluation process is intended to give the employee and supervisor feedback to assist in goal setting.   A minimum of 5 participants should be utilized.  Our methodology for using this information is that your input will be combined with input from others to develop summary statements or themes which may appear across multiple responses.   You may remain anonymous or feedback to the employee may be attributed to you if you so indicate by checking the box below.

Please indicate your preference to remain anonymous or have your input attributed to you. 

 I prefer to remain anonymous    You may identify me as the source of input

Employee Name:  
Employee Title:
 
Employee Dept:
 
Evaluator’s Relationship to Employee:
 Peer
 Staff
 Supervisor
 Other
           

 

INSTRUCTIONS:

  • For each leadership competency below, check the box that best describes the employee’s demonstrated performance.  The rating scale ranges 1 – 5, with a 1 indicating a low level of performance and a 5 indicating the highest level of performance.  Provide supporting comments and examples in the space provided or attach additional pages.

 

INNOVATION
1      
2    
3        
 4        
5      
An effective leader strategically improves the quality of the institution, protects the long-term health of the organization, promotes the success of all and sustains the mission based on knowledge of the organization, its environment and future trends.           
Comments:

 

COLLABORATION
1
2
3
4
5
An effective leader develops and maintains responsive, cooperative, mutually beneficial, and ethical internal and external relationships that nurture diversity, promote the success of all, and sustain the mission.          
Comments:

 

COMMUNICATION SKILLS
1
2
3
4
5
An effective leader uses clear listening, speaking, and writing skills to engage in honest, open dialogue at all levels, to promote the success of all, and to sustain the mission.
         
Comments:

 

ENCOURAGE THE HEART
1
2
3
4
5
An effective leader keeps hope and determination alive through creation of an environment that recognizes, values, and rewards the positive efforts and contributions that each individual makes to the mission, vision, and goals of the organization.
         
Comments:

 

INTEGRITY
1
2
3
4
5
An effective leader ensures that their actions, as well as their professional values, intentions, and principles are in alignment with and guided by the mission and established policies and procedures.
         
Comments:

 

STEWARDSHIP
1
2
3
4
5
An effective leader equitably and ethically sustains human resources, processes and information as well as physical and financial assets to fulfill the mission.
         
Comments:

 

JOB KNOWLEDGE
1
2
3
4
5
An effective leader demonstrates a current understanding of knowledge specific to their area of responsibility through the application of related procedures, principles, theories or concepts.
         
Comments:

 

Additional Questions:

 

What does this employee do well? 
What should this employee continue doing?
What should this employee do more of?
What should this employee do less of?
Any other comments or information you wish to share?

 

Thank you for completing this 360° Evaluation, please return to      ______