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)
Survey 10 (Comment boxes only)
Survey 11 (Single rating per competency)
Survey 12 (Slide-bar scale)

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.

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

Establishing Focus/Direction

Agree Unsure Disagree N/A
  1. Functions well under stress, deadlines, and/or significant workloads.
  1. Makes sure that employees understand how their work relates to organizational goals.
  1. Stays focused even when under pressure and stress.
  1. Sets appropriate goals for employees.
  1. Maintains self-control when personally criticized.

Decision Making

Agree Unsure Disagree N/A
  1. Seeks input from key people who should be involved in, or will be affected by, decisions
  1. Does not lose sight of the big picture when making decisions
  1. Asks for additional information when making critical decisions.
  1. Exercises good judgment by making sound and informed decisions.
  1. Assesses the risks, benefits, and potential impact of a number of options when deciding a course of action

Change Management

Agree Unsure Disagree N/A
  1. Addresses organizational and departmental resistance to changes.
  1. Effective in implementing new organizational vision and values.
  1. Supports the Company's efforts to implement changes.
  1. Assists others in understanding changes to the organization.
  1. Supports new initiatives for organizational changes to improve effectiveness.

Managing Risk

Agree Unsure Disagree N/A
  1. Is knowledgeable of standard risk management principles.
  1. Bases decisions on patterns found in fluid/changing information.
  1. Evaluates risks against acceptable risk levels.
  1. Responds appropriately to unexplained or unanticipated events.
  1. Committed to implementing rules and procedures to minimize risk.


Agree Unsure Disagree N/A
  1. Is professional and courteous in interactions with auditors and regulators.
  1. Creates and maintains necessary regulatory documentation.
  1. Addresses issues quickly before they develop into major problems.
  1. Ensures the company meets legal requirements/standards regarding employees.
  1. Complies with trade agreements affecting international companies.

Empowering Others

Agree Unsure Disagree N/A
  1. Set clear goals for assignments.
  1. Lets employees make their own decisions.
  1. Lets employees complete tasks according to their methods.
  1. Expresses confidence in the abilities of others.
  1. Gives employees input into the decision making process.

Strategic Focus

Agree Unsure Disagree N/A
  1. Understands & contributes to development of strategic goals.
  1. Understands their role within the organization.
  1. Focuses attention on treating the causes of problems rather than simply addressing the symptoms.
  1. Communicates goals and objectives to employees.
  1. Looks for opportunities to enhance contributions to the bottom line.

Organizational Fluency

Agree Unsure Disagree N/A
  1. Is aware of other organizational cultures to compare/contrast with the current organizational culture.
  1. Gets things done through the department.
  1. Able to explain departmental policies and procedures to others.
  1. Understands departmental policies and procedures.
  1. Able to deal with sensitive issues with tact and professionalism.

  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.