<p> Unity Care Group “Creating Healthier Communities”</p><p>360 DEGREE EVALUATION FORM ***CONFIDENTIAL*** (For employees to evaluate their supervisor)</p><p>Name of Employee completing form (Print): Dept: </p><p>Supervisor being evaluated (Print): Date: </p><p>Scale of 1-5 (1=Not at all, 3=Sometimes, 5=All the time)</p><p>How often do you have 15-min meetings/meetings with your supervisor? 1 2 3 4 5 Comments: </p><p>Does your supervisor return your calls when you page him/her? 1 2 3 4 5 Comments: </p><p>Do you feel you get the support you need in order to be effective in your job? 1 2 3 4 5 Comments: </p><p>Do you receive both positive and negative feedback from your supervisor? 1 2 3 4 5 Comments: </p><p>Does your supervisor ask you to make suggestions to improve the program? 1 2 3 4 5 Comments: </p><p>How often do you participate in training? 1 2 3 4 5 Comments: </p><p>Does your supervisor encourage you to share your ideas and concerns? 1 2 3 4 5 Comments: </p><p>Is your supervisor approachable and open to constructive criticism? 1 2 3 4 5 Comments: </p><p>Page 1 of 3 Unity Care Group “Creating Healthier Communities”</p><p>How effective is your supervisor in dealing with conflict resolution? 1 2 3 4 5 Comments: </p><p>Do you feel supported by your supervisor? 1 2 3 4 5 Comments: </p><p>Does your supervisor challenge you to think creatively (outside the box)? 1 2 3 4 5 Comments: </p><p>Does your supervisor recognize your good work or affirm your contribution to the organization? 1 2 3 4 5 Comments: </p><p>Does your supervisor effectively communicate organizational goals and mission with you and your team? 1 2 3 4 5 Comments: </p><p>Does your supervisor utilize team building strategies or exercises to promote camaraderie? 1 2 3 4 5 Comments: </p><p>In what areas would you like additional training and support? Comments: </p><p>What changes would you like to see happen at Unity Care? Comments: </p><p>What is your confidence level in the management team (High, Medium, Low) please give examples Comments: </p><p>In what ways do you demonstrate the mission and values of Unity Care? Comments: </p><p>Page 2 of 3 Unity Care Group “Creating Healthier Communities”</p><p>Would you be open to discussing your feedback in more detail with Human Resources or Executive Management? Yes No </p><p>Page 3 of 3</p>