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)
Survey 10 (Comment boxes only)
Survey 11 (Single rating per competency)
Survey 12 (Slide-bar scale)

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.

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 .

Change Management

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

Commitment To Result

Agree Unsure Disagree N/A
  1. Maintains persistence and dedication to achieving results.
  1. Takes immediate action toward goals.
  1. Coordinates all department activities into a cohesive team effort.
  1. Creates a sense of urgency among the store team members to complete activities, which drive sales.
  1. Encourages commitment in others to obtain results.


Agree Unsure Disagree N/A
  1. Able to organize work.
  1. Sets long-term and short-term goals.
  1. Encourages me to take on greater responsibility.
  1. Establishes goals and objectives.
  1. Communicates goals and objectives to employees.


Agree Unsure Disagree N/A
  1. Able to adapt to new situations.
  1. Is open to alternative ways to accomplish goals
  1. Can handle changes without complaining.
  1. Identifies new opportunities to achieve goals
  1. Works effectively during periods of change.

Passion To Learn

Agree Unsure Disagree N/A
  1. Embraces new technology and procedures.
  1. Demonstrates through personal behavior the commitment to high standards of performance.
  1. Takes initiative for own learning and development.
  1. Stays up-to-date on emerging technologies.
  1. Takes advantage of training opportunities when they arise.

Establishing Focus/Direction

Agree Unsure Disagree N/A
  1. Excellent at managing time.
  1. Makes sure that employees understand and identify with the team's mission.
  1. Maintains focus when handling several problems or tasks simultaneously.
  1. Functions well under stress, deadlines, and/or significant workloads.
  1. Makes sure that employees understand how their work relates to organizational goals.

Administrative Skill

Agree Unsure Disagree N/A
  1. Completes reports on-time.
  1. Has strong technical/computer skills.
  1. Enthusiastic about taking on challenging projects.
  1. Able to develop, justify and present a budget.
  1. Strong organizational skills to keep the workspace and department in order


Agree Unsure Disagree N/A
  1. Creates a safe environment for idea-sharing.
  1. Analyzes current procedures and identifies opportunities for improvement.
  1. Implements best practices within the department.
  1. Fosters a creative and innovative work environment.
  1. Searches for opportunities and innovative ways to improve the organization.

Interpersonal Skills

Agree Unsure Disagree N/A
  1. Is trusted by peers and co-workers; others are willing to confide in him/her
  1. Uses tact, compassion, and sensitivity in interactions with others.
  1. Provides constructive feedback in a way that fosters acceptance and development.
  1. Builds a strong rapport with co-workers.
  1. Effectively manages conflicts by dealing with them directly and immediately


Agree Unsure Disagree N/A
  1. Works in a way that makes others want to work with her/him.
  1. Completes assigned work tasks.
  1. ...takes personal responsibility for results.
  1. Holds herself / himself accountable to goals / objectives
  1. Sets a good example.

Co-worker Development

Agree Unsure Disagree N/A
  1. Takes immediate action on poor performance
  1. Adapts coaching and mentoring approach to meet the style or needs of individuals
  1. Works to identify root causes of performance problems
  1. Gives others development opportunities through project assignments and increased job responsibilities
  1. Provides ongoing feedback to co-workers on their development progress

Strategic Insight

Agree Unsure Disagree N/A
  1. Identifies potential problems before they become critical incidents.
  1. Formulates policies and strategies for addressing the Company's important challenges.
  1. Implements long-term solutions to problems.
  1. Understands the Company's strengths and weaknesses and uses this information to create optimal solutions to problems.
  1. Anticipates business cycles and trends and makes adjustments in a timely manner.

  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.