Action - 360 Degree Feedback Survey Sample #9

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)

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.


Definite Strength Meets Standards Needs Development N/A
  1. Works quickly when faced with difficult problems.
  1. Motivates & supports others to gain skills
  1. Gets the job done.
  1. Does whatever it takes (within reason) to get the job done.
  1. Makes effective decisions, even when under pressure.


Definite Strength Meets Standards Needs Development N/A
  1. Listens and responds to issues and problems
  1. ...Overall Performance
  1. Works effectively in the department.
  1. Effective in performing his/her job.
  1. Able to organize work.


Definite Strength Meets Standards Needs Development N/A
  1. Implements changes as a result of having listened to employees
  1. Effective in incorporating new ideas.
  1. Open to the perspectives/viewpoints of others.
  1. Acts decisively in frequently changing and uncertain environment.
  1. Identifies new opportunities to achieve goals

Emotional Intelligence

Definite Strength Meets Standards Needs Development N/A
  1. Is able to express themselves clearly.
  1. Is able to manage their own emotions.
  1. Accurately perceives the emotional reactions of others.
  1. Helps to make decisions and solve problems using knowledge about how others will react in certain situations.
  1. Is able to control their own emotions.

Communication Skills

Definite Strength Meets Standards Needs Development N/A
  1. Asks follow-up questions as needed.
  1. Chooses the communication medium (ie. email, voice mail, memo, project document) that reflects the needs of the content. (ie. urgency, confidentiality, content scope)
  1. Communications with department leadership
  1. Communicates effectively with all levels of the organization.
  1. Checks for understanding throughout conversations or group presentations/discussions

Persuasion and Influence

Definite Strength Meets Standards Needs Development N/A
  1. Seeks to obtain consensus or compromise.
  1. Understanding what others need.
  1. Attempts to persuade others rather than simply control them.
  1. Communicates effectively with others.
  1. Persuades others to consider alternative points of view.


Definite Strength Meets Standards Needs Development N/A
  1. Understands & contributes to development of strategic goals.
  1. Achieves goals.
  1. Makes sure that I have a clear idea of our group's goals.
  1. Sets high expectations and goals; encourages others to support the organization.
  1. Conducts timely follow-up; keeps others informed on a need to know basis.

Technology Use/Management

Definite Strength Meets Standards Needs Development N/A
  1. Applies complex rules and regulations to maintain optimal system performance.
  1. Maximizes the use of new technology to deliver products and services.
  1. Supports employee training and development initiatives regarding implementation of technology.
  1. Understands and is committed to implementing new technologies.
  1. Adopts the implementation of new technology into the workplace.


Definite Strength Meets Standards Needs Development N/A
  1. Creates value within the Company by building networks.
  1. Supports and encourages relationships that are created by diverse team members.
  1. Collaborates with others to accomplish goals and objectives.
  1. Builds alliances between departments and teams.
  1. Seeks to reduce institutional roadblocks to information sharing.


Definite Strength Meets Standards Needs Development N/A
  1. Relates to all kinds of people tactfully
  1. Actively and openly participates in group meetings.
  1. Comes across as a reliable, committed team member
  1. Encourages teamwork and collaboration.
  1. Encourages collaboration with other departments.

  1. Overall, please rate the effectiveness of .

  2. Strengths

  3. Areas for Development

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