Adaptability - 360 Degree Feedback Survey Sample #3





Questionnaires Measuring Adaptability:
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:
Adaptability, Self Management, Supervisory Skills, Delegation, Quality, Safety, Customer Focus, Co-worker Development, Coaching, Strategic Insight, 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.






Adaptability

Does Not
Exhibit this
Competency
Seldom
Exhibits this
Competency
Sometimes
Exhibits this
Competency
Usually
Exhibits this
Competency
Always
Exhibits this
Competency
  1. You can adjust plans and procedures.
  1. You are able to adjust to new plans and procedures.
  1. You perform a wide range of tasks, respond to changes in direction and priorities and accept new challenges, responsibilities, and assignments.
  1. You are able to adapt to new environments.
  1. You are aware of changes to team personnel.
Please feel free to provide any comments to help explain your answers?

Self Management

Does Not
Exhibit this
Competency
Seldom
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Competency
Sometimes
Exhibits this
Competency
Usually
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Competency
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Competency
  1. You do not allow own emotions to interfere with the performance of others.
  1. You deal with conflict by controlling own emotions by listening, being flexible, and sincere in responding.
  1. You analyze interpersonal problems instead of reacting to them.
  1. You consciously control own negative emotions in order to keep team morale up.
  1. You use patience and self-control in working with customers and associates.
Please feel free to provide any comments to help explain your answers?

Supervisory Skills

Does Not
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Competency
Seldom
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Competency
Sometimes
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Competency
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Competency
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Competency
  1. I am diligent about completing performance assessments on time.
  1. I maintain a calm demeanor when addressing stressful issues in the workplace.
  1. I contribute to a productive work environment for the team.
  1. You determine appropriate staffing levels for the job.
  1. You are respectful toward employees.
Please feel free to provide any comments to help explain your answers?

Delegation

Does Not
Exhibit this
Competency
Seldom
Exhibits this
Competency
Sometimes
Exhibits this
Competency
Usually
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Competency
Always
Exhibits this
Competency
  1. You allow subordinates to use their own methods and procedures.
  1. You entrust subordinates with important tasks.
  1. You clearly define duties and tasks to be completed.
  1. You set clear and reasonable expectations for others and follow through on their progress.
  1. You define goals and objectives for subordinates.
Please feel free to provide any comments to help explain your answers?

Quality

Does Not
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Competency
Seldom
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Competency
Sometimes
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Competency
Usually
Exhibits this
Competency
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Exhibits this
Competency
  1. I ensure the hiring of employees who are dedicated to delivering exceptional quality in every aspect of their work.
  1. I understand and use established quality procedures/controls.
  1. I adopt and implement best practices when it comes to quality procedures.
  1. I communicate quality standards clearly.
  1. I view quality issues as a system failure rather than an individual failure.
Please feel free to provide any comments to help explain your answers?

Safety

Does Not
Exhibit this
Competency
Seldom
Exhibits this
Competency
Sometimes
Exhibits this
Competency
Usually
Exhibits this
Competency
Always
Exhibits this
Competency
  1. You support safety programs and procedures.
  1. You are aware of osha safety guidelines.
  1. You develop a culture of safety.
  1. You keep accurate safety records.
  1. You encourage others to attend safety training.
Please feel free to provide any comments to help explain your answers?

Customer Focus

Does Not
Exhibit this
Competency
Seldom
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Competency
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Competency
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Competency
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Competency
  1. I exceed expectations of the customers.
  1. You effectively troubleshoot customer issues.
  1. You give feedback to the customer regularly.
  1. I create an environment that enables customers to receive excellent service.
  1. You look for opportunities that have a positive impact on customers.
Please feel free to provide any comments to help explain your answers?

Co-worker Development

Does Not
Exhibit this
Competency
Seldom
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Competency
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Competency
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Competency
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Competency
  1. You work to identify root causes of performance problems
  1. You take immediate action on poor performance
  1. You set and clearly communicate expectations, performance goals, and measurements to others
  1. You give others development opportunities through project assignments and increased job responsibilities
  1. You provide ongoing feedback to co-workers on your development progress
Please feel free to provide any comments to help explain your answers?

Coaching

Does Not
Exhibit this
Competency
Seldom
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Competency
Sometimes
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Competency
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Competency
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Competency
  1. You develop the skills and capabilities of others.
  1. You coach employees in how to strengthen knowledge and skills to improve work performance.
  1. You address employee behavior problems effectively.
  1. You provide clear, motivating, and constructive feedback.
  1. You help employees to understand responsibilities, authority, and expectations.
Please feel free to provide any comments to help explain your answers?

Strategic Insight

Does Not
Exhibit this
Competency
Seldom
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Competency
Sometimes
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Competency
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Competency
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Competency
  1. I develop a strategic vision for the future.
  1. You create values statements to ensure all employees are working under the same guiding principles.
  1. You understand the Company's strengths and weaknesses and uses this information to create optimal solutions to problems.
  1. I pursue strategic alliances with valued partners.
  1. You identify root causes of 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 are aware of other organizational cultures to compare/contrast with the current organizational culture.
  1. You are able to deal with sensitive issues with tact and professionalism.
  1. You are able to explain departmental policies and procedures to others.
  1. You anticipate problems that may affect the department.
  1. You are effective in communicating with others within the organization.
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.