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)
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.






Action

Does Not
Exhibit this
Competency
Seldom
Exhibits this
Competency
Sometimes
Exhibits this
Competency
Usually
Exhibits this
Competency
Always
Exhibits this
Competency
  1. You decide to act rather than remain passive.
  1. You start immediately working on assignments.
  1. I am decisive when making decisions.
  1. You work at a quick pace.
  1. I avoid "Analysis Paralysis" through action.
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
Exhibits this
Competency
Usually
Exhibits this
Competency
Always
Exhibits this
Competency
  1. You make sure that employees understand and identify with the team's mission.
  1. You maintain focus when handling several problems or tasks simultaneously.
  1. You maintain self-control when personally criticized.
  1. You help guide employees with prioritizing tasks.
  1. You function well under stress, deadlines, and/or significant workloads.
Please feel free to provide any comments to help explain your answers?

Supervisory Skills

Does Not
Exhibit this
Competency
Seldom
Exhibits this
Competency
Sometimes
Exhibits this
Competency
Usually
Exhibits this
Competency
Always
Exhibits this
Competency
  1. I delegate assignments to employees according to seniority.
  1. I am clear about the expectations that employees will be held accountable for.
  1. I am diligent about completing performance assessments on time.
  1. You decide which team members are assigned to each job.
  1. You communicate on a daily basis with the team at the start of each shift.
Please feel free to provide any comments to help explain your answers?

Initiative

Does Not
Exhibit this
Competency
Seldom
Exhibits this
Competency
Sometimes
Exhibits this
Competency
Usually
Exhibits this
Competency
Always
Exhibits this
Competency
  1. I am proactive and get things done.
  1. I encourage others on the team to suggest process improvements.
  1. I anticipate problems and initiate plans to address them.
  1. You do the right thing without being told.
  1. You confront problems immediately without supervisor instructions.
Please feel free to provide any comments to help explain your answers?

Managing Risk

Does Not
Exhibit this
Competency
Seldom
Exhibits this
Competency
Sometimes
Exhibits this
Competency
Usually
Exhibits this
Competency
Always
Exhibits this
Competency
  1. I work effectively to avoid risk.
  1. I view risks as potential opportunities for profit.
  1. I evaluate the probability of a risk event occurrence.
  1. You reward risky ideas that may yield significant benefits.
  1. I look for opportunities to turn a risk event into an advantage for the company.
Please feel free to provide any comments to help explain your answers?

Regulatory/Compliance

Does Not
Exhibit this
Competency
Seldom
Exhibits this
Competency
Sometimes
Exhibits this
Competency
Usually
Exhibits this
Competency
Always
Exhibits this
Competency
  1. You maintain historical records and documents as needed/required.
  1. I ensure appropriate followup for regulatory violations.
  1. You comply with trade agreements affecting international companies.
  1. I tain and coordinate activies of compliance officers.
  1. I create and administer training initiatives on compliance and regulations.
Please feel free to provide any comments to help explain your answers?

Co-worker Development

Does Not
Exhibit this
Competency
Seldom
Exhibits this
Competency
Sometimes
Exhibits this
Competency
Usually
Exhibits this
Competency
Always
Exhibits this
Competency
  1. You take immediate action on poor performance
  1. You work to identify root causes of performance problems
  1. You adapt coaching and mentoring approach to meet the style or needs of individuals
  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
Please feel free to provide any comments to help explain your answers?

Others

Does Not
Exhibit this
Competency
Seldom
Exhibits this
Competency
Sometimes
Exhibits this
Competency
Usually
Exhibits this
Competency
Always
Exhibits this
Competency
  1. You respect the opinions of other employees.
  1. You treat others with respect and dignity.
  1. You consistently demonstrate ability and willingness to trust others.
  1. You form working relationships with employees from other departments.
  1. You support the efforts of other employees in implementing solutions to problems.
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
Usually
Exhibits this
Competency
Always
Exhibits this
Competency
  1. You understand departmental policies and procedures.
  1. You are effective in communicating with others within the organization.
  1. You are aware of other organizational cultures to compare/contrast with the current organizational culture.
  1. You understand the current organizational culture.
  1. You are adept at navigating within the culture of 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.