Achievement - 360 Degree Feedback Survey Sample #10

360 Feedback Survey

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)

Thank you for providing feedback for the recipient above. As you respond, please draw on your first-hand experience with this individual in the past 12 months. Rate each item using the scale shown. If you don't feel you have enough first-hand information to rate a certain item, please choose the Not Applicable option. Comments can be very helpful; at a minimum where you give a particularly high or low rating, please share your reasons in the comment section for that competency. Your responses will be compiled with feedback from others and presented to the recipient to help guide their ongoing development.

Partially completed forms can be saved by using the Save/Still Working button at the bottom of the page. You may return at a later time to complete/edit the form. Your saved responses will be shown each time you re-visit the feedback form. When you are certain that you have completed your responses and will be not making any changes, click the Complete button.


  • Accepts setbacks and challenges as improvement opportunities
  • Establishes stretch goals to advance skills and output.
  • Allocates resources as needed to accomplish organizational goals.
  • Is determined to complete tasks regardless of obstacles that may occur.
  • Uses established goals and performance measures to keep track of performance.
If [Participant Name] were to make improvements in Achievement, what are your suggestions for how he/she can improve this?

Continual Improvement

  • Encourages an employee culture of continuous improvement to seek out better ways of doing things.
  • Analyzes processes to determine areas for improvement.
  • Promotes training and development opportunities to enhance job performance.
  • Looks for ways to expand current job responsibilities.
  • Searches for new methods, techniques, and processes that increase efficiency and reduce costs.
If [Participant Name] were to make improvements in Continual Improvement, what are your suggestions for how he/she can improve this?


  • Open to the suggestions of others.
  • Asks others for their ideas and opinions.
  • Accepts the views of others.
  • Considers other's opinion and suggestions.
  • Is easy to approach with ideas and opinions.
If [Participant Name] were to make improvements in Feedback, what are your suggestions for how he/she can improve this?

Supervisory Skills

  • Holds employees accountable for work assignments.
  • Follows the company standard procedures for allocating assignments.
  • Resolves disputes in a way that quickly reaches mutual agreement.
  • Delegates effectively.
  • Values the opinions of subordinates.
If [Participant Name] were to make improvements in Supervisory Skills, what are your suggestions for how he/she can improve this?

Communication Skills

  • Delivers well-prepared, informed, poised and succinct presentations.
  • Chooses the communication medium (ie. email, voice mail, memo, project document) that reflects the needs of the content. (ie. urgency, confidentiality, content scope)
  • Addresses issues of key importance to stakeholders.
  • Presents issues, ideas, and strategy concisely and clearly.
  • Communicates effectively with colleagues and customers
If [Participant Name] were to make improvements in Communication Skills, what are your suggestions for how he/she can improve this?
Overall, please rate the effectiveness of [Participant Name Here].


Areas for Development

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