This document is a 360 degree evaluation form for providing feedback on an employee named [Employee Name Here]. Respondents are asked to consider their experiences working with the employee over the last few months and rate them on various competencies and responsibilities using a never, sometimes, always scale. The feedback will be anonymously compiled and presented to the employee to guide their ongoing development. The form addresses competencies such as accountability, achievement, adaptability, administrative skills, attitude, client focus, commitment to results, communication skills, conflict management, decision making, emotional intelligence, empowering others, establishing focused direction, flexibility, interpersonal skills, leadership, and management.

1. 360 DEGREE EVALUATION FORM
You have been selected to provide feedback to [Employee Name Here]. Your feedback is an
important part of our company’s leadership development process. This tool 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 assessment form, please think about your experiences working with this
individual during the last ________ months. Your responses will be merged with other’s
feedback and presented to [Employee Name Here] to guide them in their on-going development.
Comments will be shared anonymously as written.
Accountability Never Sometimes Always
1. Can be counted on to do what they say they are going to do.
2. Is aware of problems or issues that may affect the
organization.
3. Informs supervisor of progress without having to be asked
about it.
4. Keeps supervisor informed of recent events.
5. Able to effectively limit risk-taking while maintaining optimal
performance.
6. Defines roles, rights, and responsibilities of employees.
7. Tackles issues head on and finds solutions.
8. Takes ownership of mistakes and learns from them.
9. Encourages employees to set challenging but achievable goals.
Achievement Never Sometimes Always
11. Accepts setbacks and challenges as improvement opportunities
12. Completes work to a high technical standard
13. Completes work to given time frame and to budget

2. 14. Schedules time for self and others to optimize high priority
and long term actions. Monitors progress towards business
goals.
15. Set high standards in their performance
16. Systematically works to improve the organization
Adaptability Never Sometimes Always
17. Learns from personal experiences and/or mistakes.
18. Performs a wide range of tasks, responds to changes in
direction and priorities and accepts new challenges,
responsibilities, and assignments.
19. Recognizes and implements changes to enhance efficiency and
effectiveness.
20. Works effectively in dynamic and changing work
environments.
21. Able to quickly learn new ways of performing their job.
22. Able to work within uncertain environments.
23. Able to work effectively with new people and new teams.
24. Is proactive and takes steps to prepare for changes in the
workplace.
25. Integrates information from a variety of sources to develop
new and creative solutions.
26. Adjusts behaviors and language in dealing with individuals
from other cultures or customs.
Administrative Skills Never Sometimes Always
27. Completes reports on-time.
28. Enthusiastic about taking on challenging projects.

3. 29. Implements and uses performance measures.
30. Takes responsibility for decisions.
Attitude Never Sometimes Always
31. Builds open and trusting relationships.
32. Contributes to a positive and fun work environment.
33. Shows by their actions that they trust in the positive intentions
of others.
34. Treats all people fairly and with respect.
35. Works to eliminate unnecessary work or barriers that get in
others' way.
Client Focus Never Sometimes Always
36. Ensures client commitments and requirements are met or
exceeded
37. Obtains feedback to ensure client needs are being met.
38. Looks for opportunities that have a positive impact on Clients.
39. Interacts with clients to define roles, expectations, and
responsibilities.
40. Promotes, implements, maintains and enhances relationships
with clients.
41. Anticipates problems that the client may encounter.
Commitment To Result Never Sometimes Always
42. Coordinates all department activities into a cohesive team
effort.
43. Creates and maintains a store environment that welcomes
customers by providing an appealing, interactive and exciting
store.

4. 44. Looks for opportunities to maximize sales by making
merchandise presentation customer friendly and accessible.
45. Willing to do whatever it takes-not afraid to have to put in
extra effort.
Communication Skills Never Sometimes Always
46. Able to demonstrate persuasiveness in pursuit of objectives.
47. Addresses issues of key importance to stakeholders.
48. An effective listener who is responsive to information needs.
49. Conveys ideas confidently and succinctly.
50. Demonstrates clear verbal and written communication skills
51. Shares important information with others.
52. Has the confidence to communicate effectively to all levels
(from CEO down) of the organization, external customers,
suppliers, as well as the senior counsel of other companies.
53. Listens attentively and without interrupting to team members
and customers
54. Responds to questions with accurate and complete answers
55. Able to use multiple methods of communication.
Conflict Management Never Sometimes Always
56. Deals effectively with employee grievances.
57. Discusses conflict situations with supervisor.
58. Assists team members by helping them see the other point of
view.
59. Helps employees to think through alternative ways to resolve
conflict situations.

5. 60. Tries to understand others' point of view before making
judgments
Decision Making Never Sometimes Always
61. Asks for additional information when making critical
decisions, rather than operate blindly
62. Assesses the risks, benefits, and potential impact of a number
of options when deciding a course of action
63. Breaks complex issues into manageable parts and organizes
them in a systematic way before making decisions
64. Effectively prioritizes and organizes themselves and their
workload.
65. Makes decisions that positively impact team/departmental
performance
66. Makes effective, practical decisions based on factual
information.
67. Makes sound and timely decisions.
68. Evaluates short and long term consequences when making
decisions.
69. Is not afraid to take risks that may yeild significant results.
70. Aware of his/her own skills and abilities.
71. Is confident in the decisions they make.
72. Takes charge when in charge.
Emotional Intelligence Never Sometimes Always
73. Is able to control their emotions.
74. Accurately perceives the emotional reactions of others.
75. Is able to express clearly.

6. 76. Recognizes the meanings of emotion and their relationships to
various issues.
Empowering Others Never Sometimes Always
77. Encourages employees to solve problems on their own.
78. Distributes the workload to subordinates.
79. Allows individuals to be responsible for their decisions.
80. Sets clear goals for others to accomplish.
81. Encourages others to obtain necessary skills and training.
82. Removes obstacles to the success of others.
Establishing Focused Direction Never Sometimes Always
83. Aligns the department's goals with the goals of the
organization.
84. Stays focused even when under pressure and stress.
85. Excellent at managing time.
86. Makes sure that employees understand how their work relates
to organizational goals.
87. Helps guide employees with prioritizing tasks.
88. Maintains self-control when personally criticized.
Flexibility Never Sometimes Always
89. Effective in incorporating new ideas.
90. Encourages others to adopt new procedures.
91. Implements changes as a result of having listened to
employees
92. Is open to alternative ways to accomplish goals

7. 93. Can handle changes without complaining.
94. Willing to change ideas or perceptions based on new
information or contrary evidence which is presented.
95. Adapts to new technology and systems.
Interpersonal Skills Never Sometimes Always
96. Successfully resolves conflicts and grievances to a win-win
solution.
97. Adapts management style to meet the needs of the individual
or situation.
98. Coaches others how to communicate with influence and
persuasion.
99. Coaches team on how to offer alternative solutions in order to
help customers achieve desired results
100. Comes across as credible, knowledgeable and sincere
101. Creates an atmosphere that supports the open expression of
ideas
102. Demonstrates awareness of how specific actions, or inaction,
could affect others
103. Effectively manages conflicts by dealing with them directly
and immediately
104. Encourages team and team members to seek and respond to
constructive criticism
105. Gives honest feedback and suggestions for improvement.
106. Is a role model for others
107. Is trusted by peers and co-workers; others are willing to
confide in him/her

8. 108. Keeps and maintains confidentiality and trust.
109. Positively impacts his/her team's morale, sense of belonging,
and participation
110. Remains poised and rational in debates, seeking an
understanding of all sides
111. Seeks input from key people who should be involved in, or
will be affected by, decisions.
112. Uses knowledge and charisma rather than position, power, or
coercion to influence others
113. Values the opinions of others.
Leadership Never Sometimes Always
114. Highly effective supervisor.
115. Maximizes the efforts of all team members.
116. Demonstrates leadership and courage in critical situations.
117. Is a leader within the department.
118. Effectively leads others.
119. Able to lead the organization.
120. Able to align manpower, design work, an allocate tasks to
achieve goals.
121. Able to conceptualize, organize, staff and manage a program
with results.
122.Motivates and challenges employees to attain a shared vision.
123. Coaches others and prepares them for current and future
business demands.
124. Critiques own performance as a means of self-improvement

9. and initiates self-development activities
125. Maintains high ethical standards.
126. Gives direct, constructive, and actionable feedback.
127. Guides individuals toward goal achievement using negotiation,
teamwork/collaboration, motivation and staff development skills.
128. Influences others on his/her team to reach goals, improve
performance, and try new things
129. Inspires a shared vision of being the best.
130. Looks for opportunities to enhance contributions to the bottom
line.
131. Improves work quality for the team.
Management Never Sometimes Always
132. Delegate tasks effectively
133. Keep staff informed about what is happening in the
organization
134. Makes you feel enthusiastic about your work
135. Sets an example for others to follow
136. Manages staff and prepares work schedules appropriately.
137. Assigns specific duties appropriately.
138. Actively listens for feedback from subordinates.
139. Uses feedback to modify duties, tasks, requirements, and goals
when appropriate.
140. Keeps subordinates informed.
Passion To Learn Never Sometimes Always

10. 141. Actively seeks to learn by asking questions and listening to all
store associates.
142. Constantly enhances product knowledge through
experimentation and play.
143. Critiques own performance and learn from experience as a
source of continuous improvement.
144. Demonstrates through personal behavior the commitment to
high standards of performance.
145. Is motivated by the desire to be "the best".
Persuasion and Influence Never Sometimes Always
146. Able to express own goals and needs.
147. Attempts to persuade others rather than simply control them.
148. Understanding what others need.
149. Obtains the support of others to accomplish goals.
150. Have excellent influencing/negotiating skills.
151. Persuades others to consider alternative points of view.
152. Prepares influential and convincing reports.
153. Takes a long-term view and acts as a catalyst and champion of
change.
154. Persuades others to perform tasks that are viewed as difficult
or undesirable.
Punctuality Never Sometimes Always
155. Starts the workday when scheduled.
156. Avoids making personal phone calls during working hours.

11. 157. Starts meetings on time.
158. Arrives to meetings on time.
159. Maintains an efficient schedule of activitis.
160. Conducts appointments at scheduled start time.
161. Invoices clients on a timely basis.
162. Responds to requests for information in a timely maner.
Responsible Never Sometimes Always
163. Works in a way that makes others want to work with her/him.
164. honest
165. sets a good example
166. Acts as a resource without removing individual responsibility.
167. Behavior is ethical and honest.
Strategic Focus Never Sometimes Always
168. Creates plans to develop and promote organizational and area
strengths, as well as to address weaknesses.
169. Focuses attention on treating the causes of problems rather
than simply addressing the symptoms.
170. Monitors performance of each market within the Area,
utilizing reports to ensure sales growth, cost management, and
profitability targets are met.
171. Sustains or achieves a competitive advantage for the
organization by analyzing the best practices and lessons learned
from other organizations.
172. Understands & contributes to development of strategic goals.

12. Teamwork
Never Sometimes Always
173. Act as an effective teamplayer
174. Actively participates as a team member
175. Applies knowledge of team behavior to help achieve
organizational goals and objectives.
176. Builds consensus and shares relevant information.
177. Creates a culture that fosters and values collaboration.
178. Builds relationships across boundaries and with key
stakeholders by developing informal and formal networks.
179. Coaches team members
180. Creates opportunities to learn with other team members
181. Emphasizes the importance of getting individuals to work as a
team
182. Facilitates team discussions and problem-solving
183. Fosters respect and understanding among team members
184. Models excellent team behavior; recognizes "out-of-bounds"
behavior and addresses as appropriate.
185. Promotes a team spirit within and outside department; partners
with other groups.
A. What changes should _______________ make in order to develop professionally?

13. B. What areas need improvement?
C. Do you have any final comments for ______________?
Yes No
Please explain?
D. What do you like best about working with _______________?