Attitude - 360 Degree Feedback Survey Sample #8

Questionnaires Measuring Attitude:
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

You have been selected to complete a self-assessment questionnaire as part of a 360-degree feedback assessment. 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.

Respond to the assessment form based on your work experiences during the previous 12 months. Your responses will be merged with other people's feedback and presented to you in your on-going development. Comments from others will be shared anonymously, as written.

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. You visibly support and encourages diversity in style and background.
  1. You contribute to a positive and fun work environment.
  1. You treat all people fairly and with respect.
  1. You show by your actions that you trust in the positive intentions of others.
  1. You build open and trusting relationships.


Agree Unsure Disagree N/A
  1. You are effective in incorporating new ideas.
  1. You adapt to circumstances as needed.
  1. You identify new opportunities to achieve goals
  1. You are able to adapt to new situations.
  1. You encourage others to adopt new procedures.

Continual Learning

Agree Unsure Disagree N/A
  1. You take charge of your training and skills enhancement.
  1. You share best practices with others and learn from others.
  1. You are open to new ideas and concepts.
  1. You take the initiative to learn new skills.
  1. You build on your strengths while addressing your weaknesses.

Establishing Focus/Direction

Agree Unsure Disagree N/A
  1. You stay focused even when under pressure and stress.
  1. You maintain focus when handling several problems or tasks simultaneously.
  1. You set appropriate goals for employees.
  1. You maintain self-control when personally criticized.
  1. You align the department's goals with the goals of the organization.


Agree Unsure Disagree N/A
  1. You identify problems and issues needing resolution.
  1. You balance risks and costs with the reward and probabilities of success when decisions.
  1. You identifiy opportunities for progress and innovation.
  1. You identify the root cause of a problem.
  1. You select the appropriate techniques for analysis.


Agree Unsure Disagree N/A
  1. When working on a problem in a team, I often am the first to suggest possible solutions.
  1. You seize upon opportunities available.
  1. I seize upon chances to improve the department's prospects.
  1. I immediately work on solving problems.
  1. I inspire others to perform above expectations.

Results Oriented

Agree Unsure Disagree N/A
  1. You work toward achievement of goals even when confronted with obstacles.
  1. You demonstrate the personal confidence to "stay the course," even when faced with difficulty
  1. You encourage a high-energy, fun work environment and coaches others on how to do the same
  1. You do not become distracted by non-issues or interruptions.
  1. You stay focused on meeting the needs of customers.


Agree Unsure Disagree N/A
  1. You establish goals and objectives.
  1. You consistently provide me with timely feedback for improving my performance.
  1. You effectively organize resources and plans
  1. You are able to organize work.
  1. You set long-term and short-term goals.

Interpersonal Skills

Agree Unsure Disagree N/A
  1. You demonstrate compassion and understanding of others.
  1. You use tact, compassion, and sensitivity in interactions with others.
  1. You effectively manage conflicts by dealing with them directly and immediately
  1. You demonstrate willingness to work with others.
  1. You are a role model for others

Client Focus

Agree Unsure Disagree N/A
  1. I identify opportunities that enhance the client's experience.
  1. I provide a responsive service that meets the needs of clients.
  1. You received good feedback from clients.
  1. I act with integrity in all client interactions.
  1. I accept responsibility for ensuring client satisfaction.

Co-worker Development

Agree Unsure Disagree N/A
  1. You work to identify root causes of performance problems
  1. You give others development opportunities through project assignments and increased job responsibilities
  1. You adapt coaching and mentoring approach to meet the style or needs of individuals
  1. You set and clearly communicate expectations, performance goals, and measurements to others
  1. You provide ongoing feedback to co-workers on your development progress

  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.