360° Feedback Form

Name VISHAL ANIL BHAMRE

Employee Code
669
Department PIPING

Objective:
Every organization has its own culture and values and a 360° survey emphasizes on just that. We have customized this
survey to reflect our core values by including questions about integrity, leadership, development and communication.
By means of this feedback form, we strive to achieve an overall sense of direction on the development of employees and
their communication of our leadership team.
Your feedback will help the organization in formulating the best strategy for a holistic growth of individuals, teams and
in a broader sense, the organization.
---------------------------------------------------------------------------------------------------------------------------------------------------

Section 1.
Self-Feedback:
You have been asked to evaluate yourself as part of a 360-degree feedback process. Other employees, including your
manager(s), peers, direct reports and/or others will also evaluate you.
In this manner, you will be provided with a comprehensive, multi-perspective (i.e., 360-degree) view of your
performance. The objective is to provide you with feedback to allow you to improve your performance, resulting in
improved team performance, and organizational effectiveness.

1
Part 1- Accountability (Are you/ Do you)

S.N Statement Needs Could Benefit Performs Excels; Is a Role Don’t

Improvement from as Above Model Know/
Development Expected Average for Not
Others Aware
1 Act like an owner when you make 
decisions.
2 Tackle issues head on and find 
solutions.
3 Take responsibility for results 
4 Take ownership of mistakes and 
learns from them.
5 Inform the management of 
progress without having to be
asked about it
Any Additional Comments?

Part 2- Communication Skills (Are you/ Do you)

S.N Statement Needs Could Benefit Performs Excels; Is a Role Don’t

Improvement from as Above Model Know/
Development Expected Average for Not
Others Aware
1 Accurately attend to/ understand 
ideas which are exchanged.
2 An effective listener who is 
responsive to information needs
3 Check for understanding 
throughout conversations or
group presentations/discussions

2
4 Convey ideas confidently and 
succinctly.
5 Deal with difficult situations 
calmly and confidently
6 Deliver difficult messages to co- 
workers in an appropriate manner
7 Have 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.
8 Listen actively & speaks clearly 
and directly.
9 Visible and approachable 
10 Present issues, ideas, and strategy 
concisely and clearly.
Any Additional Comments?

Part 3- Situational Awareness (Are you/ Do you)

S.N Statement Needs Could Benefit Performs Excels; Is a Role Don’t

Improvement from as Above Model Know/
Development Expected Average for Not
Others Aware
1 Accept the views of others. 
2 Actively seek feedback from 
others.
3 Ask others for their ideas and 
opinions.
4 Looks to others for input 

3
5 Seeks and utilizes data from 
several sources.
Any Additional Comments?

Part 4- Problem Solving (Are you/ Do you)

S.N Statement Needs Could Benefit Performs Excels; Is a Role Don’t

Improvement from as Above Model Know/
Development Expected Average for Not
Others Aware
1 Have the ability to solve problems 
at root cause rather than at
symptom level
2 Able to develop innovative 
solutions to problems
3 Collect relevant information and 
data.
4 Make judgments based upon 
relevant information.
5 Are aware of problems or issues 
that may affect the organization?
Any Additional Comments?

4
Part 5- Teamwork (Are you/ Do you)

S.N Statement Needs Could Benefit Performs Excels; Is a Role Don’t

Improvement from as Above Model Know/
Development Expected Average for Not
Others Aware
1 Come across as a reliable, 
committed team member
2 Contribute to and supports team 
decision-making process
3 Create opportunities to learn with 
other team members
4 Demonstrate compassion and 
respect for others through actions;
are concerned about their work
and non-work issues
5 Facilitate team discussions and 
problem-solving
6 Help other managers in need of 
assistance, such as providing
needed resources (co-workers,
supplies, etc.)
7 Open to new ideas that may 
change own goals for benefit of the
team
8 Open to the suggestions of others 
when working on a problem?
9 Foster teamwork rather than 
individual competition
10 Encourage Open Communication 
Any Additional Comments?

5
Section 2.
Manager/ Direct Reporting Authority Feedback:
Name of Manager being Evaluated: Mr. Sashi Warrior (Please leave blank in case your reporting is directly to the Management/MD)
You have been nominated to provide feedback for the manager listed above. Your feedback is an important part of your
Manager’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 your
tenure. Your responses will be merged with other's feedback and presented to the manager to guide them in their on-
going development.
Part 1- Accountability

S.N Statement Needs Could Benefit Performs Excels; Is a Role Don’t

Improvement from as Above Model Know/
Development Expected Average for Not
Others Aware
1 Acts like an owner when they 
make decisions.
2 Can be counted on to do what 
they say they are going to do.
3 Defines roles, rights, and 
responsibilities of employees
4 Tackles issues head on and finds 
solutions.
5 Takes responsibility for results. 
6 Takes ownership of mistakes and 
learns from them.
7 Is someone you can trust. 
8 Is someone who is there when you 
need them.

6
9 Encourages employees to take on 
greater responsibilities
10 Informs supervisor of progress 
without having to be asked about
it
Any Additional Comments?

Part 2- Communication Skills

S.N Statement Needs Could Benefit Performs Excels; Is a Role Don’t

Improvement from as Above Model Know/
Development Expected Average for Not
Others Aware
1 Accurately attends 
to/understands ideas which are
exchanged.
2 An effective listener who is 
responsive to information needs
3 Checks for understanding 
throughout conversations or
group presentations/discussions
4 Communicates the vision of the 
organization to all employees
5 Conducts regular performance 
feedback discussions with
individuals and teams
6 Considers the audience in how the 
communication is presented.
7 Conveys ideas confidently and 
succinctly.
8 Conveys priorities with right sense 

7
 of urgency and importance.
9 Informs others about changes or 
developments in plans and goals
10 Deals with difficult situations 
calmly and confidently
Any Additional Comments?

Part 3- Situational Awareness

S.N Statement Needs Could Benefit Performs Excels; Is a Role Don’t

Improvement from as Above Model Know/
Development Expected Average for Not
Others Aware
1 Accepts the views of others. 
2 Asks others for their ideas and 
opinions.
3 Seeks and utilizes data from 
several sources.
4 Seeks feedback to enhance 
performance.
5 Actively seeks feedback from 
others.
Any Additional Comments?

Part 4- Leadership

S.N Needs Could Benefit Performs Excels; Is a Role Don’t

Improvement from as Above Model Know/

8
 Development Expected Average for Not
Others Aware
1 Maximizes the efforts of all team 
members
2 Uses persuasion and influence 
instead of micromanaging
employees
3 Able to influence others 
4 Able to organize the work of others 
5 Acts decisively in implementing 
decisions
6 Holds co-workers accountable for 
assignments and commitments
7 Critiques own performance as a 
means of self-improvement and
initiates self-development
activities
8 Demonstrates empathy for the 
impact of change on people and
processes
9 Encourages and is receptive to 
working out problems and
challenges --- no reluctance from
team members to come forward
with concerns/issues.
10 Implements decision and 
evaluates results.
Any Additional Comments?

9
Part 5- Problem Solving

S.N Statement Needs Could Benefit Performs Excels; Is a Role Don’t

Improvement from as Above Model Know/
Development Expected Average for Not
Others Aware
1 Ability to solve problems at root 
cause rather than at symptom
level
2 Able to develop innovative 
solutions to problems
3 Analyzes alternatives and selects a 
course of action.
4 Assumes new and difficult 
challenges and manages them as
opportunities.
5 Identifies fresh approaches and 
shows a willingness to question
traditional assumptions.
6 Analyzes systems and processes 
for opportunities to gain efficiency.
7 Selects operating indicators to 
track organizational performance
over time and communicates
current status to the organization
8 Willingness and comfort level in 
handling multiple and often times
conflicting priorities.
9 Is aware of problems or issues 
that may affect the organization?
10 Looks for opportunities to 
enhance contributions to the
bottom line?
Any Additional Comments?

10
Part 6- Teamwork

S.N Statement Needs Could Benefit Performs Excels; Is a Role Don’t

Improvement from as Above Model Know/
Development Expected Average for Not
Others Aware
1 Creates a culture that fosters and 
values collaboration
2 Comes across as a reliable, 
committed team member
3 Demonstrates compassion and 
respect for others through actions;
is concerned about their work and
non-work issues
4 Ensures that the right people are 
on the team in the appropriate
roles, including who should be
team leader for a particular
project/situation.
5 Facilitates conflict resolution 
discussions between individuals
in different teams
Any Additional Comments?

11