Adaptability - 360 Degree Feedback Survey Sample #10

360 Feedback Survey

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)

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.


  • Ability to recognize the potential benefits of change, and create an infrastructure which supports change.
  • Recognizes and implements changes to enhance efficiency and effectiveness.
  • Able to work effectively with new people and new teams.
  • Works effectively in dynamic and changing work environments.
  • Develops insights and applies innovative solutions to projects and problems.
If [Participant Name] were to make improvements in Adaptability, what are your suggestions for how he/she can improve this?


  • Shows by their actions that they trust in the positive intentions of others.
  • Builds open and trusting relationships.
  • Is gracious and professional in their interactions with others.
  • Treats all people fairly and with respect.
  • Works to eliminate unnecessary work or barriers that get in others' way.
If [Participant Name] were to make improvements in Attitude, what are your suggestions for how he/she can improve this?


  • Effective in performing his/her job.
  • Shown significant improvement in job performance.
  • Works effectively in the department.
  • Works well in this position.
  • Able to organize work.
If [Participant Name] were to make improvements in Performance, what are your suggestions for how he/she can improve this?

Technology Use/Management

  • Supports employee training and development initiatives regarding implementation of technology.
  • Proficient in the use of technical systems and processes.
  • Identifies gaps between actual and needed technical competencies and provides recommendations for required training.
  • Adopts the implementation of new technology into the workplace.
  • Applies complex rules and regulations to maintain optimal system performance.
If [Participant Name] were to make improvements in Technology Use/Management, what are your suggestions for how he/she can improve this?


  • Promotes the understanding of how the department affects the organization overall.
  • Partners with peers to obtain influence within the Company.
  • Seeks an understanding of diverse functions within the Company.
  • Collaborates with others to accomplish goals and objectives.
  • Forges mutually beneficial relationships between individuals with diverse backgrounds.
If [Participant Name] were to make improvements in Partnering/Networking, what are your suggestions for how he/she can improve this?
Overall, please rate the effectiveness of [Participant Name Here].


Areas for Development

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