Action - 360 Degree Feedback Survey Sample #11

360 Feedback Survey

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)

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.

To what extent does [Participant Name] exhibit the following ...

SELECT the rating that best reflects the employee's performance in the areas listed.


What does Action mean?
It means that ...
  • You are not afraid to take corrective action when necessary.
  • You motivate & supports others to gain skills
  • You work quickly when faced with difficult problems.
  • You do whatever it takes (within reason) to get the job done.
  • You make effective decisions, even when under pressure.

To what extent does this person exhibit Action?
Select from one of the ratings below.

Self Management

What does Self Management mean?
It means that ...
  • You use patience and self-control in working with customers and associates.
  • You are aware of personal impact on others and adjusts behavior to create a positive leadership presence.
  • You analyze interpersonal problems instead of reacting to them.
  • You do not allow own emotions to interfere with the performance of others.
  • You consciously control own negative emotions in order to keep team morale up.

To what extent does this person exhibit Self Management?
Select from one of the ratings below.


What does Performance mean?
It means that ...
  • You have great overall performance
  • You set a high standard for job performance.
  • You shown significant improvement in job performance.
  • You are able to organize work.
  • You work well in this position.

To what extent does this person exhibit Performance?
Select from one of the ratings below.

Time Management

What does Time Management mean?
It means that ...
  • You do not become flustered by deadlines and timelines.
  • You use agendas when chairing or facilitating meetings.
  • You complete high-priority work within required timelines.
  • You focus on tasks that have high priority.
  • You set clearly defined goals.

To what extent does this person exhibit Time Management?
Select from one of the ratings below.

Developing Others

What does Developing Others mean?
It means that ...
  • You create a work environment that fosters positive feedback to employees.
  • You recognize and celebrates accomplishments of others.
  • You provide constructive feedback to others.
  • You try to ensure employees are ready to move to the next level.
  • You support the successes of other employees.

To what extent does this person exhibit Developing Others?
Select from one of the ratings below.

Organizational Fluency

What does Organizational Fluency mean?
It means that ...
  • You are able to explain departmental policies and procedures to others.
  • You get things done through the department.
  • You understand departmental policies and procedures.
  • You are adept at navigating within the culture of the department.
  • You anticipate problems that may affect the department.

To what extent does this person exhibit Organizational Fluency?
Select from one of the ratings below.

Areas for Development

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