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Upward Feedback Form PDF

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DHRM August 2001

Upward Feedback Form for Supervisors


Supervisor’s Name _____________________________________ Date:_____________

This questionnaire is designed to provide your immediate supervisor’s Reviewer with feedback. The
information will be used by the reviewer to assist the supervisor in developing his/her capabilities.

Although the completion of this form is optional, we encourage you to take this opportunity to share feedback
on your supervisor’s performance. Please be frank. In order to be most helpful, please answer the questions
in a candid manner.

The results will be combined with other performance feedback and will be shared with the supervisor in an
anonymous way. Your individual form will not be discussed with your supervisor.

Using the rating key below, please mark the space that best matches the degree to which you observe this
person demonstrating the listed behavior. Mark “N/O” only if you have had no opportunity to see the person
demonstrate the behavior. You may skip any questions that are not applicable to your situation.

How well does your


How highly do you value supervisor meet your
this trait? needs on each trait?
Manager Competencies N/O 5 4 3 2 1 N/O 5 4 3 2 1
High value No value Very well Not well

Leadership
Supports others to accomplish business objectives.

Expects, communicates, and encourages quality


performance from others.
Recognizes and rewards good ideas from others.

Builds constructive relationships.

Makes thoughtful, wise decisions.

Takes action to improve practices and procedures.

Is sought out by others for counsel and advice.

Is proactive, responding to opportunities, solving


problems, planning for action.
Anticipates problems and effectively plans solutions.

Communication
Communicates changes in methods and/or work
assignments clearly and promptly.
Communicates honestly and constructively.

Shares information openly and candidly.

Is receptive to suggestions for changing or improving


the way work is accomplished
DHRM August 2001
How well does your
How highly do you value supervisor meet your
this trait? needs on each trait?
Manager Competencies N/O 5 4 3 2 1 N/O 5 4 3 2 1
High value No value Very well Not well

Technical Knowledge
Possesses the necessary job skills and knowledge.

Is able to provide technical assistance as needed.

Acquires knowledge of emerging technologies or


developments in her/his field.
Organizational Knowledge
Understands the agency’s mission and is able to
communicate goals and objectives to staff.
Understands and acts according to policies,
practices, and procedures.
Supports organizational changes.

Customer Focus
Identifies and responds to internal and external
customer needs.
Is committed to the satisfaction of internal and
external customers.
Is responsive to customer and employee requests.

Treats both internal and external customers with


fairness, respect, and integrity.
Teamwork
Involves others in discussions of how to achieve
team objectives.
Is receptive to suggestions for changing or improving
the way work is accomplished

The section you have just completed may not convey everything you would like to say about your supervisor.
The questions below will allow you to add any supplementary information you wish to express.

What traits of your supervisor’s style do you feel are most effective?

What traits of your supervisor’s style do you feel are least effective?

What specific things could your manager do that would enable you to do your job more effectively?

Employee’s Name: (Optional) _______________________

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