Change Management - 360 Degree Feedback Survey Sample #10

360 Feedback Survey

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)

Thank you for providing feedback for the recipient above. As you respond, please draw on your first-hand experience with this individual in the past 12 months. Rate each item using the scale shown. If you don't feel you have enough first-hand information to rate a certain item, please choose the Not Applicable option. Comments can be very helpful; at a minimum where you give a particularly high or low rating, please share your reasons in the comment section for that competency. Your responses will be compiled with feedback from others and presented to the recipient to help guide their ongoing development.

Partially completed forms can be saved by using the Save/Still Working button at the bottom of the page. You may return at a later time to complete/edit the form. Your saved responses will be shown each time you re-visit the feedback form. When you are certain that you have completed your responses and will be not making any changes, click the Complete button.

Change Management

  • Effective in implementing new organizational vision and values.
  • Supports the Company's efforts to implement changes.
  • Inspires others to accept changes.
  • Develops a strategy for implementing changes.
  • Is a leading force driving changes.
If [Participant Name] were to make improvements in Change Management, what are your suggestions for how he/she can improve this?


  • Is open to alternative ways to accomplish goals
  • Open to the perspectives/viewpoints of others.
  • Adapts to circumstances as needed.
  • Works effectively during periods of change.
  • Identifies new opportunities to achieve goals
If [Participant Name] were to make improvements in Flexibility, what are your suggestions for how he/she can improve this?

Continual Improvement

  • Encourages an employee culture of continuous improvement to seek out better ways of doing things.
  • Looks for ways to expand and learn new job skills.
  • Analyzes processes to determine areas for improvement.
  • Promotes training and development opportunities to enhance job performance.
  • Looks for ways to improve work processes and procedures.
If [Participant Name] were to make improvements in Continual Improvement, what are your suggestions for how he/she can improve this?


  • Capitalizes on opportunities as they become available.
  • Immediately works on solving problems.
  • Takes action to establish clear and concise deadlines for tasks to be completed.
  • Initiates the development of new products.
  • Goes above and beyond the stated goals.
If [Participant Name] were to make improvements in Initiative, what are your suggestions for how he/she can improve this?

Managing Risk

  • Is aware of the financial implications of certain risks.
  • Seeks to retain the best and brightest employees.
  • Evaluates risks against acceptable risk levels.
  • Responds appropriately to unexplained or unanticipated events.
  • Has the knowledge and skills to accurately identify risks in the workplace.
If [Participant Name] were to make improvements in Managing Risk, what are your suggestions for how he/she can improve this?
Overall, please rate the effectiveness of [Participant Name Here].


Areas for Development

Please give any final comments or suggestions for [Participant Name Here]'s assessment.