{{company_name}}
{{company_address}}
Phone: {{phone}} | Email: {{email}} | Web: {{website}}
Form Title
360 Feedback Survey Form
Purpose
Use the 360 feedback survey form to support an objective and developmental performance conversation.
Employee Information
| Field | Value |
|---|---|
| Full Name | {{employee_name}} |
| Employee ID | {{employee_id}} |
| Job Title | {{job_title}} |
| Department | {{department}} |
| Manager | {{manager_name}} |
| Effective Date | {{effective_date}} |
Details
| Field | Value / Notes |
|---|---|
| Strengths | _______________________ |
| Development Areas | _______________________ |
| Examples | _______________________ |
| Suggested Actions | _______________________ |
| Rater Type | _______________________ |
Instructions
- Complete prior to the scheduled conversation.
- Share with the employee in advance where appropriate.
- Submit signed copies to HR for the employee file.
Certification
I confirm this assessment is based on objective evidence and discussion.
Signatures
| Signature | Date | |
|---|---|---|
| Employee: {{employee_name}} | ____________________ | {{date}} |
| Manager: {{manager_name}} | ____________________ | {{date}} |
Review Period & Participants
| Field | Detail |
|---|---|
| Employee | {{employee_name}} ({{employee_id}}) |
| Role | {{job_title}}, {{department}} |
| Reviewer | {{manager_name}} |
| Review Period | From last review to {{date}} |
| Review Type | Annual / Mid-year / Probation |
Rating Scale
| Rating | Definition |
|---|---|
| 1 — Below Expectations | Performance is significantly below the bar; improvement plan required. |
| 2 — Developing | Performance meets some expectations; targeted growth needed. |
| 3 — Meets Expectations | Reliably delivers against role expectations. |
| 4 — Exceeds Expectations | Consistently delivers above the bar with broader impact. |
| 5 — Exceptional | Role-model performance; significant organizational impact. |
Objective Achievement
| Objective | Target | Result | Rating |
|---|---|---|---|
Competency Assessment
| Competency | Evidence | Rating |
|---|---|---|
| Delivery & Execution | ||
| Communication & Stakeholder Mgmt | ||
| Collaboration & Teamwork | ||
| Leadership / Ownership | ||
| Values & Behaviours |
Development Plan
- Top three development priorities for the next review period.
- Specific learning experiences (on-the-job, coaching, formal training) committed.
- Support required from the manager, HR, or other stakeholders.
- Measurable indicators of progress with review dates.
Career Conversation Summary
Capture the employee's aspirations, readiness signals, and next-role considerations. Document any agreed actions and timelines.
Acknowledgement
Document Control
| Field | Value |
|---|---|
| Document Owner | Human Resources — {{company_name}} |
| Category | Performance Review |
| Version | 1.0 |
| Effective Date | {{date}} |
| Next Review | Annually from effective date |
| Approved By | {{manager_name}} |
| Classification | Internal — Confidential |
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