Change Management - 360 Degree Feedback Survey Sample #3





Questionnaires Measuring Change Management:
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:
Change Management, Objectives, Flexibility, Creativity, Cultural Awareness, Performance, Interpersonal Skills, Conflict Management, Planning
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.






Change Management

Does Not
Exhibit this
Competency
Seldom
Exhibits this
Competency
Sometimes
Exhibits this
Competency
Usually
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Competency
Always
Exhibits this
Competency
  1. I am a leading force driving changes.
  1. You assist others in understanding changes to the organization.
  1. I facilitate change with minimal resistance.
  1. I am able to get team members to change their attitudes.
  1. I develop strategies for implementing changes.
Please feel free to provide any comments to help explain your answers?

Objectives

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 work toward achieving established goals and objectives.
  1. You set long-term and short-term goals.
  1. You are able to organize work.
  1. You encourage others to take on greater responsibility.
  1. You are able to establish realistic goals.
Please feel free to provide any comments to help explain your answers?

Flexibility

Does Not
Exhibit this
Competency
Seldom
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Competency
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Competency
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Competency
Always
Exhibits this
Competency
  1. You are open to adapting thoughts, behaviors, and strategies in response to evolving situations and new information.
  1. You are capable of adapting workflows to accommodate new regulations or policies.
  1. You perform more and varried processes on the production line.
  1. You are open to alternative ways to accomplish goals
  1. You scale up production capabilities in response to growing service demands.
Please feel free to provide any comments to help explain your answers?

Creativity

Does Not
Exhibit this
Competency
Seldom
Exhibits this
Competency
Sometimes
Exhibits this
Competency
Usually
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Competency
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Exhibits this
Competency
  1. You are creative.
  1. You add value to the department/organization.
  1. You develop solutions to challenging problems.
  1. You inspire creativity in your team.
  1. You conceive, implement and evaluate ideas.
Please feel free to provide any comments to help explain your answers?

Cultural Awareness

Does Not
Exhibit this
Competency
Seldom
Exhibits this
Competency
Sometimes
Exhibits this
Competency
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Competency
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Exhibits this
Competency
  1. You understand the impact that your culture may have on interactions between individuals.
  1. You understand how your own cultural background can impact the way you communicate and interact with others.
  1. You treat others with dignity and respect.
  1. I help other employees to become more culturally sensitive.
  1. You are aware of the similarities and differences among and between cultural groups.
Please feel free to provide any comments to help explain your answers?

Performance

Does Not
Exhibit this
Competency
Seldom
Exhibits this
Competency
Sometimes
Exhibits this
Competency
Usually
Exhibits this
Competency
Always
Exhibits this
Competency
  1. You are effective in performing your job.
  1. You listen and respond to issues and problems
  1. You shown significant improvement in job performance.
  1. You have great overall performance
  1. You work effectively in the department.
Please feel free to provide any comments to help explain your answers?

Interpersonal Skills

Does Not
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Competency
Seldom
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Competency
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Competency
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Competency
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Competency
  1. I maintain a high degree of honesty and integrity.
  1. You see value in the diversity of individuals on the team.
  1. I give credit where credit is due.
  1. I appreciate the extra efforts made by coworkers.
  1. You demonstrate good communication with colleagues and customers.
Please feel free to provide any comments to help explain your answers?

Conflict Management

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 am supportive of consensus and power sharing.
  1. I address concerns about the availability of limited resources.
  1. You examine differences and disagreements for creative and strategic resolutions.
  1. I investigate opportunities to achieve mutually beneficial solutions to conflicts.
  1. I attempt to determine the root sources of grievances.
Please feel free to provide any comments to help explain your answers?

Planning

Does Not
Exhibit this
Competency
Seldom
Exhibits this
Competency
Sometimes
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Competency
Usually
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Competency
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Exhibits this
Competency
  1. You assess the potential impact of changes to the strategic plan.
  1. You are able to develop logistics plans to move material through a multi-step supply chain.
  1. You anticipate resources needed to successfully implement a plan or project.
  1. You establish and monitor timeframes and timelines.
  1. I develop plans used to accomplish urgent or critical tasks.
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.