Accountability - 360 Degree Feedback Survey Sample #8

Questionnaires Measuring Accountability:
Survey 1 (4-point scale; Competency Comments)
Survey 2 (4-point scale; Competency Comments)
Survey 3 (5-point scale; Competency Comments)
Survey 4 (5-point scale; radio buttons)
Survey 5 (4-point scale; words)
Survey 6 (4-point scale; words)
Survey 7 (5-point scale; competency comments; N/A)
Survey 8 (3-point scale; Agree/Disagree words; N/A)
Survey 9 (3-point scale; Strength/Development; N/A)
Survey 10 (Comment boxes only)
Survey 11 (Single rating per competency)
Survey 12 (Slide-bar scale)
Self-Assessment Instructions

You have been selected to complete a self-assessment questionnaire as part of a 360-degree feedback assessment. Your feedback is an important part of 's leadership development process. This tool is intended to gather broad feedback in the core competencies and role responsibilities that are important for the on-going success of our organization.

Sample Result Document:
Sample Results
Method of use: As part of the review process, managers will receive feedback from peers and staff. It is recognized that not all participants will be able to assess an individual's performance in all areas. The feedback received will be utilized as input to the manager's performance and on-going development plan.

You may sign out at any time by pressing the Save button at the end of the form and then closing your browser. You may return later to pick up where you left off. When you are done, press the Complete button.

Please complete your response by .


Agree Unsure Disagree N/A
  1. You encourage employees to take on greater responsibilities.
  1. You can be counted on to do what you say you are going to do.
  1. You develop goals and establishes objective measures of success.
  1. You are someone who is trustworthy.
  1. You define roles, rights, and responsibilities of the team.

Administrative Skill

Agree Unsure Disagree N/A
  1. You have strong technical/computer skills.
  1. You complete reports on-time.
  1. You implement and use performance measures.
  1. You are enthusiastic about taking on challenging projects.
  1. You accurately implement contract provisions.

Change Management

Agree Unsure Disagree N/A
  1. You support new initiatives for organizational changes to improve effectiveness.
  1. I am able to get team members to change their attitudes.
  1. I am a leading force driving changes.
  1. I am able to get department employees to accept new changes.
  1. I develop plans for following through on the changes.

Managing Risk

Agree Unsure Disagree N/A
  1. You are aware of the financial implications of certain risks.
  1. You accurately determine appropriate risk levels (i.e., levels of acceptable risk).
  1. You create a risk profile for projects and teams.
  1. You have the knowledge and skills to accurately identify risks in the workplace.
  1. You track and monitors incidents that may increase the risk of adverse consequences.


Agree Unsure Disagree N/A
  1. You keep informed of various regulations and procedures.
  1. You know who to contact at various regulatory agencies if needed.
  1. You are professional and courteous in interactions with auditors and regulators.
  1. You maintain a state of readiness to address new and changing regulations and procedures.
  1. You are familiar with EEOC, FLSA, OSHA and ERISA acts/standards.

Customer Focus

Agree Unsure Disagree N/A
  1. I actively listen to concerns from customers.
  1. You have excellent communication with customers.
  1. I accept responsibility for ensuring customer satisfaction.
  1. You help customers to feel satisfied with our work/services.
  1. You ensure customers are comfortable with the services provided.

Organizational Fluency

Agree Unsure Disagree N/A
  1. You are able to explain departmental policies and procedures to others.
  1. You are adept at navigating within the culture of the department.
  1. You are effective in communicating with others within the organization.
  1. You anticipate problems that may affect the department.
  1. You are aware of other organizational cultures to compare/contrast with the current organizational culture.


Agree Unsure Disagree N/A
  1. You behave in a way that is consistent with business values & code of conduct
  1. You clearly articulate a vision for your work and inspires others to support it
  1. You understand the vision of the Company and promote it ahead of any self-interests.
  1. You create a common vision for others.
  1. You demonstrate consistency between words and actions

  1. Overall, please rate the effectiveness of [Participant Name Here].

  2. Strengths

  3. Areas for Development

  4. Please give any final comments or suggestions for [Participant Name Here]'s assessment.