You have been selected to provide feedback for the person identified below. Please use this form to provide feedback about the leadership behaviors which this person demonstrates on a regular basis. The recipient of this feedback will see only a roll-up of the results, not the actual feedback forms.
Name of feedback recipient: ____________________________
Name of evaluator (Optional): ____________________________
Please return the completed form to: _______________________
Relationship to Feedback Recipient (check one):
O Manager | O Peer | O Self |
O Direct Report | O Below Direct Report | O Internal Customer |
Instructions:
Please indicate the rating that corresponds to the degree to which you observe this person demonstrating the listed leadership behavior, according to the rating key at the top of each page. N/O should be used if you have not been in situations which would afford you the opportunity to observe the behavior.
At the end of each section, please provide comments and examples which support your ratings. If you need more space for comments, please attach an additional page. Please be sure to include examples for ratings below 3 or above 7. On the back panel, please answer questions 9 and 10 according to your experience and relationship with the feedback recipient.
If you have questions, please contact human resources.
Feedback Request for Leadership Behaviors
N/O=Not Observed 1=Never 3=Seldom 5=Sometimes 7=Most of the time 10=Always
Inspires a Shared Vision
Provides direction around a vision | N/O | 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | 10 |
Translates the corporate vision into actionable plans | N/O | 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | 10 |
Creates enthusiasm about the future of the company | N/O | 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | 10 |
Shows others how their long-term interests can be realized by enlisting in a common vision | N/O | 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | 10 |
Please explain: (examples required for ratings below 3 and above 7)
Delivers Results
Makes appropriate decisions | N/O | 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | 10 |
Acts after making a decision | N/O | 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | 10 |
Takes risks | N/O | 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | 10 |
Encourages others to take risks | N/O | 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | 10 |
Supports the decisions of others | N/O | 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | 10 |
Please explain: (examples required for ratings below 3 and above 7)
Focuses on the Customer
Anticipates customer needs | N/O | 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | 10 |
Seeks customer feedback | N/O | 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | 10 |
Responds to customer feedback | N/O | 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | 10 |
Models customer focus in interactions with customers | N/O | 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | 10 |
Helps remove barriers to excellent | N/O | 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | 10 |
Please explain: (examples required for ratings below 3 and above 7)
Challenges the Process
Pursues better ways to get things done | N/O | 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | 10 |
Models breakthrough thinking | N/O | 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | 10 |
Acts as a change agent | N/O | 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | 10 |
Helps others manage through change | N/O | 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | 10 |
Please explain: (examples required for ratings below 3 and above 7)
Values People
Shows respect for others and their ideas | N/O | 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | 10 |
Encourages others' involvement in making things better | N/O | 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | 10 |
Appreciates differences between people in thought and style | N/O | 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | 10 |
Allows for flexibility in how work is accomplished | N/O | 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | 10 |
Considers others' needs when making decisions | N/O | 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | 10 |
Please explain: (examples required for ratings below 3 and above 7)
Develops Self and Others
Demonstrates personal growth and learning | N/O | 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | 10 |
Encourages continuous growth and learning in others | N/O | 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | 10 |
Acknowledges mistakes & learns from them | N/O | 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | 10 |
Sets clear performance expectations in advance | N/O | 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | 10 |
Shares positive performance feedback that is timely and direct | N/O | 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | 10 |
Shares negative performance that is timely and direct | N/O | 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | 10 |
Sends candid messages that are focused on the issue not the person | N/O | 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | 10 |
Please explain: (examples required for ratings below 3 and above 7)
Communicates with Candor
Communicates effectively and continuously | N/O | 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | 10 |
Listens to what others have to say | N/O | 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | 10 |
Shares opinions even when unpopular | N/O | 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | 10 |
Expresses disagreement earlier than later | N/O | 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | 10 |
Makes others feel safe in honestly expressing themselves | N/O | 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | 10 |
Please explain: (examples required for ratings below 3 and above 7)
Acts in the Best Interest of the Company and the Enterprise
Is visible, with positive presence | N/O | 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | 10 |
Is highly ethical and professional | N/O | 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | 10 |
Is an effective team member | N/O | 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | 10 |
Instills effective team membership in others | N/O | 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | 10 |
Models collaboration | N/O | 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | 10 |
Gets involved in making things better in the company and community | N/O | 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | 10 |
Please explain: (examples required for ratings below 3 and above 7)
9. What 2-3 behaviors would you like to see this person do differently?
More of?
Less Of?
10. What 2-3 behaviors would you like this person to continue?
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