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)
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.

Respond to the assessment form based on your work experiences during the previous 12 months. Your responses will be merged with other people's feedback and presented to you in your on-going development. Comments from others will be shared anonymously, as written.

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.

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. You strive to exceed standards of performance.
  1. You hold others to high standards of achievement.
  1. You demonstrate a well-organized and timely approach to achieve desired results
  1. You follow-up and take action when goals are not met to ensure better results in the future.
  1. You set challenging goals.

Results Oriented

Agree Unsure Disagree N/A
  1. You provide clear expectations for employees.
  1. You demonstrate the personal confidence to "stay the course," even when faced with difficulty
  1. You work toward achievement of goals even when confronted with obstacles.
  1. You direct team in prioritizing daily work activities
  1. You inspire and motivates co-workers to be productive and energetic at work


Agree Unsure Disagree N/A
  1. You demonstrate the analytical skills to do your job.
  1. You can be counted on to add value wherever you are involved.
  1. You take a lot of pride in your work.
  1. You keep yourself and others focused on constant improvement.
  1. You demonstrate the functional or technical skills necessary to do your job.

Interpersonal Skills

Agree Unsure Disagree N/A
  1. You are open and approachable
  1. You provide constructive feedback in a way that fosters acceptance and development.
  1. You effectively manage conflicts by dealing with them directly and immediately
  1. You strive for win/win solutions
  1. You value the opinions of others.

Passion To Learn

Agree Unsure Disagree N/A
  1. You demonstrate a willingness to participate in continuing education courses.
  1. You take advantage of training opportunities when they arise.
  1. You take initiative for own learning and development.
  1. You hold self and associates accountable for goal achievement.
  1. You constantly enhance product knowledge through experimentation and play.

Continual Improvement

Agree Unsure Disagree N/A
  1. You look for ways to expand and learn new job skills.
  1. You encourage an employee culture of continuous improvement to seek out better ways of doing things.
  1. You are open to the suggestions from others.
  1. You promote training and development opportunities to enhance job performance.
  1. You search for new methods, techniques, and processes that increase efficiency and reduce costs.


Agree Unsure Disagree N/A
  1. You take responsibility for things that go wrong
  1. You delegate tasks effectively
  1. You set an example for others to follow
  1. You make others feel enthusiastic about your work
  1. You are ready to offer help

Persuasion and Influence

Agree Unsure Disagree N/A
  1. You attempt to persuade others rather than simply control them.
  1. You understand what others need.
  1. You develop a good rapport with others.
  1. You ensure stakeholders are involved in the decision making process.
  1. You have excellent influencing/negotiating skills.


Agree Unsure Disagree N/A
  1. You achieve established goals.
  1. You make sure that I have a clear idea of our group's goals.
  1. You conduct timely follow-up; keeps others informed on a need to know basis.
  1. You set challenging stretch goals
  1. You establish and document goals and objectives.

Customer Focus

Agree Unsure Disagree N/A
  1. You ask questions and listen carefully to determine customer needs and to ensure that the customer's needs are met.
  1. You consider customers point of view when making decisions.
  1. You develop strong customer relationships.
  1. You do not hesitate to address customer concerns or complaints.
  1. You ensure all customer commitments and requirements are met or exceeded.


Agree Unsure Disagree N/A
  1. You build alliances between departments and teams.
  1. You develop a sense of trust in subordinates so they can freely interact and share information with others.
  1. You seek an understanding of diverse functions within the Company.
  1. You create the conditions for partnerships to grow and develop.
  1. You forge mutually beneficial relationships between individuals with diverse backgrounds.

Business Acumen

Agree Unsure Disagree N/A
  1. You ask the 'right' questions to size up or evaluate situations.
  1. You consider impact of actions on other areas of the organization.
  1. You understand complex issues and problems.
  1. You exhibit behavior that is consistent with the vision, mission, and core values of the organization
  1. You are able to align resources to meet the business needs of the company.

Strategic Insight

Agree Unsure Disagree N/A
  1. You implement long-term solutions to problems.
  1. You anticipate business cycles and trends and makes adjustments in a timely manner.
  1. You understand the Company's strengths and weaknesses and uses this information to create optimal solutions to problems.
  1. You formulate strategies and action plans to ensure successful completion of goals and objectives.
  1. You communicate vision for the department and company.


Agree Unsure Disagree N/A
  1. You delegate role to team members to accomplish goals.
  1. You anticipate potential challenges, develops plan to overcome them and then carries out the plan.
  1. You make plans and follows through.
  1. You work in an organized manner
  1. You are able to look ahead (beyond the present) when addressing the work/needs of the department.

  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.