Achievement - 360 Degree Feedback Survey Sample #8

Questionnaires Measuring Achievement:
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)

You have been selected to provide feedback for the manager listed above. 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.

In responding to the assessment form, please think about your experiences working with this individual during the last six to twelve months. Your responses will be merged with other people's feedback and presented to to guide them in their on-going development. Comments will be shared anonymously, as written, with the manager.

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.

When clicking your selection below, try to best fit the manager's actual behaviors to the scale provided.

If you are not sure, or unable to assess, select "Not Applicable" (N/A) option.

Please complete your response by .


Agree Unsure Disagree N/A
  1. Makes a plan for getting things done and drives execution of the strategic plan, actively supporting or leading initiatives to closure.
  1. Accepts setbacks and challenges as improvement opportunities
  1. Completes work to a high technical standard
  1. Completes work to given time frame and to budget
  1. Demonstrates a well-organized and timely approach to achieve desired results

Results Oriented

Agree Unsure Disagree N/A
  1. Stays focused on meeting the needs of customers.
  1. Works toward achievement of goals even when confronted with obstacles.
  1. Provides clear expectations for employees.
  1. Encourages a high-energy, fun work environment and coaches others on how to do the same
  1. Explains the "whys" behind organizational objectives


Agree Unsure Disagree N/A
  1. Can be counted on to add value wherever they are involved.
  1. Is planful and organized.
  1. Produces high quality work.
  1. Takes a lot of pride in their work.
  1. Keeps themselves and others focused on constant improvement.

Interpersonal Skills

Agree Unsure Disagree N/A
  1. Able to work with individuals at all levels of the Company.
  1. Is open and approachable
  1. Anticipates the concerns of other employees.
  1. Successfully resolves conflicts and grievances to a win-win solution.
  1. Adapts management style to meet the needs of the individual or situation.

Passion To Learn

Agree Unsure Disagree N/A
  1. Actively seeks to learn by asking questions and listening to all store associates.
  1. Critiques own performance and learns from experience as a source of continuous improvement.
  1. Constantly enhances product knowledge through experimentation and play.
  1. Takes initiative for own learning and development.
  1. Recognizes own areas for development and consciously seeks assignments that will provide practice in areas of developmental need.

Continual Improvement

Agree Unsure Disagree N/A
  1. Looks for ways to improve work processes and procedures.
  1. Looks for ways to expand and learn new job skills.
  1. Open to the suggestions from others.
  1. Looks for ways to expand current job responsibilities.
  1. Promotes training and development opportunities to enhance job performance.


Agree Unsure Disagree N/A
  1. Makes you feel enthusiastic about your work
  1. Sets an example for others to follow
  1. Keep staff informed about what is happening in the company
  1. Takes responsibility for things that go wrong
  1. Is ready to offer help

Persuasion and Influence

Agree Unsure Disagree N/A
  1. Persuades others to consider alternative points of view.
  1. Ensures stakeholders are involved in the decision making process.
  1. Understanding what others need.
  1. Able to express own goals and needs.
  1. Has excellent influencing/negotiating skills.


Agree Unsure Disagree N/A
  1. Achieves established goals.
  1. Achieves goals.
  1. Makes sure that I have a clear idea of our group's goals.
  1. Goal Setting
  1. Conducts timely follow-up; keeps others informed on a need to know basis.

Customer Focus

Agree Unsure Disagree N/A
  1. Asks questions and listens carefully to determine customer needs and to ensure that the customer's needs are met.
  1. Consistently models positive customer service attitudes.
  1. Ensures all customer commitments and requirements are met or exceeded.
  1. Develops strong customer relationships.
  1. Maintains positive customer relationships.


Agree Unsure Disagree N/A
  1. Promotes the understanding of how the department affects the organization overall.
  1. Creates the conditions for partnerships to grow and develop.
  1. Maintains infrastructure to support partnerships and networks.
  1. Builds alliances between departments and teams.
  1. Collaborates with others to accomplish goals and objectives.

Business Acumen

Agree Unsure Disagree N/A
  1. Applies the knowledge of work processes to influence the achievement of business goals
  1. Able to align resources to meet the business needs of the company.
  1. Exhibits behavior that is consistent with the vision, mission, and core values of the organization
  1. Asks the 'right' questions to size up or evaluate situations.
  1. Effectively develops and uses resources (people, time, money, supplies, equipment, and space) to improve organizational performance

Strategic Insight

Agree Unsure Disagree N/A
  1. Communicates vision for the department and company.
  1. Maintains knowledge of current trends in the industry.
  1. Identifies root causes of problems.
  1. Anticipates business cycles and trends and makes adjustments in a timely manner.
  1. Formulates policies and strategies for addressing the Company's important challenges.


Agree Unsure Disagree N/A
  1. Delegates role to team members to accomplish goals.
  1. Anticipates potential challenges, develops plan to overcome them and then carries out the plan.
  1. Able to identify the needs of the department before a major change.
  1. Makes plans and follows through.
  1. Works in an organized manner

  1. Overall, please rate the effectiveness of .

  2. Strengths

  3. Areas for Development

  4. Please give any final comments or suggestions for 's assessment.