Introduction

Inkeepingwithyourcompanysgoaltocontinuouslyimprove,weareaskingforyour
candidfeedbackontheperformanceofyourmanagerthispastyear.Asummaryofall
feedbackreceivedwillbepreparedforeachindividualmanagersothatheorshecanuse
thefeedbacktolearnanddevelopasamanager.Yourindividualfeedbackwillbe
averagedintoalltheresponsesreceivedinordertoprotectyouranonymityandensure
thattheresultseachmanagerreceivesarecompletelyconfidential.HRwillalsoprepare
anoverallsummarytoassessareasforadditionalcompanyprovidedmanagement
training.
Thankyouforyourcontributiontothisveryimportantprocess.

NameofManager:____________________________________________________
Date:__________________
Instructions
Usingthefollowingratingscale,pleasehighlightthenumberthatbestreflectsyourrating
ofyourmanagersperformanceduringthepastyear.

RatingScale
1=Unacceptable
2=Needsimprovement
3=Meetsstandard
4=Exceedsstandard
5=Outstanding
6=Havenotexperiencedorobserved

ValuingBehaviors
Seeksinputfromallteammembers
123456
Measuresresultsinsteadofindividualstyles
123456
Maintainsabalancebetween"people"issuesand"business"issues
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Showsgenuineconcernforteammembers
123456
Keepsthefocusonfixingproblemsratherthanfindingsomeonetoblame
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Treatspeoplefairly,withoutshowingfavoritism
123456

Caresaboutme
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Protectsconfidentiality
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Recognizesandrewardsmyindividualcontributionsinamannermeaningfultome
123456

InterdependenceBehaviors
Supportsateamenvironmentbyrecognizingandrewardingcollaboration,cooperation
andactivitiescontributingtoothers'success
123456
Recognizesandrewardsteamsupportiveactionsandbehaviors
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Recognizesandsupportstheworkofotherdepartments
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Doesn'tcriticizethosewhoarenotpresent
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Considerstheimpactofactionsanddecisionsonotherdepartmentsbeforeimplementing
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CommunicationBehaviors
Encouragesotherstoexpressdifferentideasandperspectives
123456
Isopentootherperspectivesandiswillingtochangehis/herpositionwhenpresented
withcompellinginformation
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Opentonegativeand/orconstructivefeedback
123456
Keepsmeinformedonstatusofmyworkandupdatesintheorganization
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Givesopenandconstructivefeedback
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Effectivelydealswithconflict
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LetsmeknowhowIamdoing
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Involvesmeindecisionmakingwhenappropriate
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Setsacleardirectionforourdepartment
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ValuingDiversityBehaviors

Ensuresthatdepartmentactivitiesareinclusivebyverifyingschedulingneeds
123456
Seeksinput/feedbackfromdiverseindividualsandgroups,includinginternal/external
customers
123456
Treatseveryonewithrespectandfairness
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LeadershipBehaviors
Encouragesandembraceschangebychallengingstatusquo
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Providescrossfunctionaldevelopmentopportunitiesforteammembers
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Encouragesandsupportsmyinvolvementintraininganddevelopmentactivitiesand
events
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Encouragesandsupportsmyinvolvementincommunityactivitiesandevents
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Encouragesandsupportsmyinvolvementincompanyactivitiesandevents
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Actionsandbehaviorsareconsistentwithwords
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Istrustworthy
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Isarolemodelforcontinuousimprovement
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Usesacoachingmanagementstyle,ratherthananauthoritarianbossmanagementstyle
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Supportsme,helpsmeachieveresults
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Supportsacustomerserviceapproachforbothinternalandexternalcustomers
123456
Dealswithissuesthatneedtobeaddressed
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Providesaclearsenseofpurposeanddirection,rolesandresponsibilities,forme
individuallyandforourgroupteammembers
123456

GeneralFeedback
Typeyouranswers,addadditionalpagesifneeded.Pleasebeasspecificaspossibleby
includingexamples.
Whatactivities,behavior,feedbackorcoachingwouldyoulikeyourmanagertostop
doing?Pleaseexplain.

Listandbrieflydescribeexamplesofthebehavior,activities,feedbackorcoachingyour
managerhasprovidedthatmakesyourjobandworkenvironmentmoreenjoyableand
meaningfultoyou.

Pleaseprovidecommentsthatyoufeelwillbemeaningfulforyourmanagertosustainor
improvehisorhereffectiveness.