Change Management - 360 Degree Feedback Survey Sample #8

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)

You have been selected to provide feedback for the manager listed above. 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.

In responding to the assessment form, please think about your experiences working with this individual during the last six to twelve months. Your responses will be merged with other people's feedback and presented to to guide them in their on-going development. Comments will be shared anonymously, as written, with the manager.

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 .

Change Management

Agree Unsure Disagree N/A
  1. Supports the Company's efforts to implement changes.
  1. Adopts changes to set and example for others to follow.
  1. Effective in dealing with ambiguous and challenging situations.
  1. Addresses organizational and departmental resistance to changes.
  1. Effective in implementing new organizational vision and values.

Commitment To Result

Agree Unsure Disagree N/A
  1. Able to focus on a task even when working alone.
  1. Conveys strong sense of own pride in Company to associates by creating a shared vision around sales and customer service.
  1. Committed to the team.
  1. Takes immediate action toward goals.
  1. Coordinates all department activities into a cohesive team effort.


Agree Unsure Disagree N/A
  1. Encourages me to take on greater responsibility.
  1. Organizes and schedules events, activities, and resources.
  1. Assures [Company] principles are understood, employed & pursued.
  1. Able to organize work.
  1. Communicates goals and objectives to employees.


Agree Unsure Disagree N/A
  1. Can handle changes without complaining.
  1. Encourages others to adopt new procedures.
  1. Effective in incorporating new ideas.
  1. Works effectively during periods of change.
  1. Willing to try new ideas.

Passion To Learn

Agree Unsure Disagree N/A
  1. Actively seeks to learn by asking questions and listening to all store associates.
  1. Persists until goals are achieved and commitments are met.
  1. Recognizes own areas for development and consciously seeks assignments that will provide practice in areas of developmental need.
  1. Holds self and associates accountable for goal achievement.
  1. Takes initiative for own learning and development.

Establishing Focus/Direction

Agree Unsure Disagree N/A
  1. Makes sure that employees understand and identify with the team's mission.
  1. Maintains self-control when personally criticized.
  1. Maintains focus when handling several problems or tasks simultaneously.
  1. Makes sure that employees understand how their work relates to organizational goals.
  1. Helps guide employees with prioritizing tasks.

Administrative Skill

Agree Unsure Disagree N/A
  1. Takes responsibility for decisions.
  1. High attention to detail.
  1. Strong organizational skills to keep the workspace and department in order
  1. Accurately implements contract provisions.
  1. Completes reports on-time.


Agree Unsure Disagree N/A
  1. Implements best practices within the department.
  1. Suggests new ideas at meetings.
  1. Analyzes current procedures and identifies opportunities for improvement.
  1. Builds upon the ideas and solutions of others.
  1. Challenges current procedures to develop other alternatives.

Interpersonal Skills

Agree Unsure Disagree N/A
  1. Values the opinions of others.
  1. Comes across as credible, knowledgeable and sincere
  1. Creates an atmosphere that supports the open expression of ideas
  1. Strives for win/win solutions
  1. Is a role model for others


Agree Unsure Disagree N/A
  1. Holds herself / himself accountable to goals / objectives
  1. Sets a good example
  1. Works in a way that makes others want to work with her/him.
  1. Is a person you can trust.
  1. Acts as a resource without removing individual responsibility.

Co-worker Development

Agree Unsure Disagree N/A
  1. Adapts coaching and mentoring approach to meet the style or needs of individuals
  1. Gives others development opportunities through project assignments and increased job responsibilities
  1. Provides ongoing feedback to co-workers on their development progress
  1. Sets and clearly communicates expectations, performance goals, and measurements to others

Strategic Insight

Agree Unsure Disagree N/A
  1. Understands the Company's strengths and weaknesses and uses this information to create optimal solutions to problems.
  1. Identifies root causes of problems.
  1. Identifies potential problems before they become critical incidents.
  1. Anticipates business cycles and trends and makes adjustments in a timely manner.
  1. Maintains knowledge of current trends in the industry.

  1. Overall, please rate the effectiveness of .

  2. Strengths

  3. Areas for Development

  4. Please give any final comments or suggestions for 's assessment.