360° Feedback Form (Multi-rater)
This 360° Feedback Form is designed to help individuals understand how their performance is viewed by others they work with regularly. Feedback is collected from multiple sources, such as supervisors, peers, direct reports, and self-evaluations. The goal is to provide a complete and honest picture of an employee’s strengths and areas for improvement. This type of feedback supports growth, helps teams work better together, and gives employees clear guidance on how to be more effective. All responses will be confidential and used to support development, not punishment.
Rating Scale
1 – Strongly Disagree
2 – Disagree
3 – Neutral
4 – Agree
5 – Strongly Agree
Basic Information
Employee Name: ____________________________________
Job Title: ___________________________________________
Department: ________________________________________
Feedback From: ☐ Manager ☐ Peer ☐ Direct Report ☐ Self
Date of Feedback: _______________
Communication
Statement | Rating |
Shares ideas and information clearly (written or spoken) | ☐1 ☐2 ☐3 ☐4 ☐5 |
Listens actively and respects others’ opinions | ☐1 ☐2 ☐3 ☐4 ☐5 |
Responds to messages and questions in a timely way | ☐1 ☐2 ☐3 ☐4 ☐5 |
Comments: |
Teamwork and Cooperation
Statement | Rating |
Works well with coworkers and builds trust | ☐1 ☐2 ☐3 ☐4 ☐5 |
Supports group decisions and shared goals | ☐1 ☐2 ☐3 ☐4 ☐5 |
Helps resolve conflicts or misunderstandings | ☐1 ☐2 ☐3 ☐4 ☐5 |
Comments: |
Leadership and Initiative
Statement | Rating |
Encourages and motivates others to do their best | ☐1 ☐2 ☐3 ☐4 ☐5 |
Takes responsibility for actions and outcomes | ☐1 ☐2 ☐3 ☐4 ☐5 |
Steps up to solve problems without being asked | ☐1 ☐2 ☐3 ☐4 ☐5 |
Comments: |
Problem Solving and Judgment
Statement | Rating |
Looks at challenges from different angles | ☐1 ☐2 ☐3 ☐4 ☐5 |
Makes fair and informed decisions | ☐1 ☐2 ☐3 ☐4 ☐5 |
Thinks clearly under pressure | ☐1 ☐2 ☐3 ☐4 ☐5 |
Comments: |
Adaptability
Statement | Rating |
Adjusts well when plans or goals change | ☐1 ☐2 ☐3 ☐4 ☐5 |
Accepts new tasks or responsibilities | ☐1 ☐2 ☐3 ☐4 ☐5 |
Handles stress and stays calm in tough situations | ☐1 ☐2 ☐3 ☐4 ☐5 |
Comments: |
Open-Ended Feedback
Please answer each of the following with short, clear comments.
What does this employee do really well?
What are some areas where this employee could improve?
Describe a moment when this employee had a positive impact.
Any other feedback that would help this employee grow?
Self-Reflection (Optional)
To be filled out by the employee.
What are you most proud of this year?
What would you like to work on next?
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