Action - 360 Degree Feedback Survey Sample #8

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)

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 effective decisions, even when under pressure.
  1. Does whatever it takes (within reason) to get the job done.
  1. Works quickly when faced with difficult problems.
  1. Displays high energy and enthusiasm on consistent basis.
  1. Is not afraid to take corrective action when necessary.

Establishing Focus/Direction

Agree Unsure Disagree N/A
  1. Makes sure that employees understand how their work relates to organizational goals.
  1. Functions well under stress, deadlines, and/or significant workloads.
  1. Maintains focus when handling several problems or tasks simultaneously.
  1. Excellent at managing time.
  1. Helps guide employees with prioritizing tasks.

Decision Making

Agree Unsure Disagree N/A
  1. Coaches team members individually when "poor" decisions are made; helps them see what could have been done differently
  1. Asks for additional information when making critical decisions.
  1. Is able to make decisions quickly.
  1. Does not lose sight of the big picture when making decisions
  1. Exercises good judgment by making sound and informed decisions.

Change Management

Agree Unsure Disagree N/A
  1. Adopts changes to set and example for others to follow.
  1. Supports new initiatives for organizational changes to improve effectiveness.
  1. Assists others in understanding changes to the organization.
  1. Works cooperatively with others to implement changes.
  1. Effective in implementing new organizational vision and values.

Managing Risk

Agree Unsure Disagree N/A
  1. Recognizes that small changes may snowball into major events.
  1. Responds appropriately to unexplained or unanticipated events.
  1. Avoids maintaining the status quo (or standard operating procedures) when addressing new and influential situations.
  1. Works within constraints of the organization.
  1. Effectively responds to critical situations to reduce potential for losses.


Agree Unsure Disagree N/A
  1. Keeps informed of various regulations and procedures.
  1. Explains regulations and procedures to others as required.
  1. Follows all safety regulations and procedures.
  1. Performs audits regularly, or without notice, to ensure proper compliance with regulations.
  1. Understands and adheres to internal and external regulations.

Empowering Others

Agree Unsure Disagree N/A
  1. Allows individuals to be responsible for their decisions.
  1. Distributes the workload to subordinates.
  1. Provides support and resources needed to accomplish goals.
  1. Encourages employees to solve problems on their own.
  1. Encourages others to obtain necessary skills and training.

Strategic Focus

Agree Unsure Disagree N/A
  1. Creates plans to develop and promote organizational and area strengths, as well as to address weaknesses.
  1. Focuses attention on treating the causes of problems rather than simply addressing the symptoms.
  1. Monitors performance of each market within the Area, utilizing reports to ensure sales growth, cost management, and profitability targets are met.
  1. Understands their role within the organization.
  1. Communicates goals and objectives to employees.

Organizational Fluency

Agree Unsure Disagree N/A
  1. Understands the current organizational culture.
  1. Able to deal with sensitive issues with tact and professionalism.
  1. Effective in communicating with others within the organization.
  1. Adept at navigating within the culture of the department.
  1. Able to explain departmental policies and procedures to others.

  1. Overall, please rate the effectiveness of .

  2. Strengths

  3. Areas for Development

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