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Action - 360 Degree Feedback Survey Sample #3





Questionnaires Measuring Action:
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)
Survey 13 (4-point scale; numbers; floating anchors)
Survey 14 (4-point scale; N/A)
Self-Assessment Instructions

Leadership at [Company] are participating in a 360-Degree Feedback assessment. As part of this process, you need to complete a self-assessment questionnaire form. Other employees, including your manager(s), peers, and direct reports will also evaluate you. In this manner, you will be provided with a comprehensive, multi-perspective (i.e., 360-degree) view of your performance as a manager. The objective is to provide you with feedback so as to allow you to improve your performance, resulting in improved team performance, and organizational effectiveness.

If you are not able to respond to an item, leave it blank and go on to the next item.

Competencies Included:
Action, Establishing Focus/Direction, Supervisory Skills, Initiative, Managing Risk, Regulatory/Compliance, Co-worker Development, Others, Organizational Fluency
Sample Result Document:
Sample Results
We encourage everyone to complete the survey. Please be honest, constructive and thoughtful in your input. The survey is designed to help us understand more about your thoughts and needs to make this a great company.

Please ensure that your submission is made between . The survey will only be available during these dates.



Edit this Survey
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Action

Does Not
Exhibit this
Competency
Seldom
Exhibits this
Competency
Sometimes
Exhibits this
Competency
Usually
Exhibits this
Competency
Always
Exhibits this
Competency
  1. I move forward on important projects.
  1. You motivate & supports others to gain skills
  1. I create opportunities and then take advantage of them.
  1. I rapidly adapt to changes in the situation.
  1. You display high energy and enthusiasm on consistent basis.
Please feel free to provide any comments to help explain your answers?

Establishing Focus/Direction

Does Not
Exhibit this
Competency
Seldom
Exhibits this
Competency
Sometimes
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Competency
Usually
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Competency
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Competency
  1. You align the department's goals with the goals of the organization.
  1. You make sure that employees understand how their work relates to organizational goals.
  1. You maintain focus when handling several problems or tasks simultaneously.
  1. You set appropriate goals for employees.
  1. You make sure that employees understand and identify with the team's mission.
Please feel free to provide any comments to help explain your answers?

Supervisory Skills

Does Not
Exhibit this
Competency
Seldom
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Competency
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Competency
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Competency
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Competency
  1. You set clear expectations for acceptable performance.
  1. I ask employees for their input in decisions that directly affects the team.
  1. I am successful in resolving personnel conflicts.
  1. I determine which team members are to be promoted to the next higher level.
  1. I resolve disputes in a way that quickly reaches mutual agreement.
Please feel free to provide any comments to help explain your answers?

Initiative

Does Not
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Competency
Seldom
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Competency
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Competency
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Competency
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Competency
  1. You act quickly to address any issues or problems.
  1. You act on own initiative to improve the department outcomes.
  1. I act with urgency when time is of the essence.
  1. You take corrective action to address performance deficiencies/issues.
  1. You independently seek out new learning opportunities to improve your skills.
Please feel free to provide any comments to help explain your answers?

Managing Risk

Does Not
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Competency
Seldom
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Competency
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Competency
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Competency
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Competency
  1. You recognize that small changes may snowball into major events.
  1. You create a risk profile for projects and teams.
  1. You evaluate risks against acceptable risk levels.
  1. You determine the impact of specific risks on marketplace.
  1. You are knowledgeable of standard risk management principles.
Please feel free to provide any comments to help explain your answers?

Regulatory/Compliance

Does Not
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Competency
Seldom
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Competency
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Competency
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Competency
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Exhibits this
Competency
  1. You use operational compliance reports to evaluate the effectiveness of internal processes.
  1. I implement strategies to ensure compliance.
  1. I used software tools to monitor compliance and track issues to help identify and respond to non-compliance.
  1. I observe, monitor and coordinate compliance activities.
  1. I implement internal control processes to detect misconduct or patterns of illegal transactions.
Please feel free to provide any comments to help explain your answers?

Co-worker Development

Does Not
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Competency
Seldom
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Competency
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Competency
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Competency
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Competency
  1. You take immediate action on poor performance
  1. You give others development opportunities through project assignments and increased job responsibilities
  1. You set and clearly communicate expectations, performance goals, and measurements to others
  1. You work to identify root causes of performance problems
  1. You provide ongoing feedback to co-workers on your development progress
Please feel free to provide any comments to help explain your answers?

Others

Does Not
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Competency
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Competency
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Competency
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Competency
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Competency
  1. You form working relationships with employees from other departments.
  1. You are able to see issues from others' perspectives.
  1. You work across boundaries within the organization.
  1. You consistently demonstrate ability and willingness to trust others.
  1. You include others in the decision making processes.
Please feel free to provide any comments to help explain your answers?

Organizational Fluency

Does Not
Exhibit this
Competency
Seldom
Exhibits this
Competency
Sometimes
Exhibits this
Competency
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Exhibits this
Competency
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Exhibits this
Competency
  1. You are aware of other organizational cultures to compare/contrast with the current organizational culture.
  1. You anticipate problems that may affect the department.
  1. You are able to use corporate politics to advance department objectives.
  1. You are effective in communicating with others within the organization.
  1. You get things done through the department.
Please feel free to provide any comments to help explain your answers?

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






  2. Strengths


  3. Areas for Development


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