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
Exhibits this
Competency
Always
Exhibits this
Competency
  1. I develop plans for following through on the changes.
  1. You are effective in implementing new organizational vision and values.
  1. I am able to get department employees to accept new changes.
  1. You support the Company's efforts to implement changes.
  1. You address organizational and departmental resistance to changes.
Please feel free to provide any comments to help explain your answers?

Objectives

Does Not
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Competency
Seldom
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Competency
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Competency
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  1. You effectively organize resources and plans
  1. You consistently provide me with timely feedback for improving my performance.
  1. You encourage others to take on greater responsibility.
  1. You communicate goals and objectives to employees.
  1. You work toward achieving established goals and objectives.
Please feel free to provide any comments to help explain your answers?

Flexibility

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 seek opportunities to improve processes and procedures to benefit the department.
  1. You allow for flexibility in the agenda for the team meeting.
  1. I allow for flexibility in setting realistic performance goals.
  1. You are willing to try new ideas.
  1. I innovate skills and modify behaviors to remain flexible in addressing important issues.
Please feel free to provide any comments to help explain your answers?

Creativity

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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Exhibits this
Competency
  1. You create a lot of new ideas.
  1. You add value to the department/organization.
  1. You develop solutions to challenging problems.
  1. You are creative and inspirational.
  1. You inspire creativity in your team.
Please feel free to provide any comments to help explain your answers?

Cultural Awareness

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 aware of my cultural views.
  1. You acknowledge your own biases in cultural interactions.
  1. You respect the views offered by individuals with different cultural backgrounds.
  1. You recognize and value individual and cultural differences.
  1. You respect others regardless of age, race, gender, nationality, or disability.
Please feel free to provide any comments to help explain your answers?

Performance

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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Exhibits this
Competency
  1. You set a high standard for job performance.
  1. You produce quality
  1. You have great overall performance
  1. You effectively organize resources and plans
  1. You listen and respond to issues and problems
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
  1. You value the opinions of others.
  1. I demonstrate positive behaviors for others to follow.
  1. I follow up on inquiries in a timely manner.
  1. I keep commitments made with coworkers.
  1. You assist those in the department who need help in meeting performance metrics.
Please feel free to provide any comments to help explain your answers?

Conflict Management

Does Not
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Competency
Seldom
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Competency
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Competency
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  1. You reframe conflicts as opportunities to innovate and create new solutions to problems.
  1. I am responsive to contentious issues.
  1. I promote mutual compromise to achieve conflict resolution.
  1. You combine ideas and viewpoints of different team members.
  1. You deal effectively with employee grievances.
Please feel free to provide any comments to help explain your answers?

Planning

Does Not
Exhibit this
Competency
Seldom
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Competency
Sometimes
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Competency
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Exhibits this
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  1. You are able to balance the needs of multiple stakeholders in developing the plan for the division.
  1. You notify staff when the plan is not on schedule.
  1. I create plans to handle complex, multi-faceted projects.
  1. I ensure staff have the supplies and resources necessary to enact the plan.
  1. I understand what equipment will be needed for the project.
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.