360 Feedback - Application & Learning Agreement

PERSONAL DETAILS:

Full Name:

Job Title:

Work Address:

Telephone:

EMAIL:______

Brief description of role & responsibilities:

Number of staff you manage(if any)______Your Pay Band______

PREVIOUS LEADERSHIP/MANAGEMENT DEVELOPMENT

Please provide information about any previous learning undertaken to support your management & leadership development & any formal qualifications held.

AIMS AND OBJECTIVES:

Please state your objectives and/or expectations for participating in 360 feedback.

______

MANAGER’S AIMS AND OBJECTIVES: (Manager to Complete)

What are your expectations in relation to the individual’s participation in 360 feedback?

COMMITMENT TO PARTICIPATION

Participation in the 360 process is learner led and requires commitment from the participant to:

Complete and return this application (a facilitator will be identified for you)
Attend a 360 Briefing session (optional)
Become familiar with the NHS Leadership Model
Identify and brief raters
Register on NHS Leadership Academy Gateway & Appraisal Hub
Set up 360 questionnaire online
Complete self assessment ratings
Monitor that ratings have been completed by others (via the Leadership Academy appraisal hub)
Arrange for your report to be closed (via the Leadership Academy appraisal hub) to enable your feedback facilitator to access it (online)
Arrange and attend 360 feedback meeting with your feedback facilitator
Complete an evaluation of the feedback session
Meet and discuss key learning points with line manager
Agree personal development plan with line manager
Undertake agreed learning and development

Line manager commitment to support the individual participant is fundamental to the effectiveness of this development process.

The line manager is expected to:

Complete 360 ratings and feedback through on-line questionnaire
Meet individual following their feedback session to discuss key learning points
Agree personal development plan
Ensure the individual is supported to undertake agreed learning and development

Please note that you should aim to ensure that a minimum of 3 people in each rater group (except line manager) completes their rating before your close your report.

Please state whether you would like to be booked onto a briefing session (these run each month) prior to receiving your instructions and setting up your 360 feedback questionnaire.

YES / NO *delete as appropriate

Signature of Applicant:

Name of Manager:

Line Manager’s Signature:______

SPECIAL REQUIREMENTS:

Do you have any special requirements that may affect your ability to participate fully in this development e.g. visual, hearing, mobility or other impairment for which you need assistance?

Yes/No If yes please state assistance needed______

______

360 Feedback - Application & Learning Agreement