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Coaching- 360 Degree Feedback Survey Sample #3





Questionnaires Measuring Coaching:
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)
Survey 13 (4-point scale; numbers; floating anchors)
Survey 14 (4-point scale; N/A)
Instructions

You have been asked to evaluate yourself as part of a 360-degree feedback process. 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:
Coaching, Professional Development, Feedback, Persuasion and Influence, Action, Bias for Action, Delegation, Change Management, Juggling Multiple Responsibilities, Objectives, Conflict Management, Teamwork
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.



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Coaching

Does Not
Exhibit this
Competency
Seldom
Exhibits this
Competency
Sometimes
Exhibits this
Competency
Usually
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Competency
Always
Exhibits this
Competency
  1. Considers the ideas and suggestions from coaches.
  1. Helps employees see possibilities by reframing problems into opportunities to develop new solutions.
  1. Helps others to understand the responsibilities and expectations of working for _____.
  1. Coaches employees in how to strengthen knowledge and skills to improve work performance.
  1. Understands the individual differences in each employee including unique working style, stress threshold, and capacity for growth.
Please feel free to provide any comments to help explain your answers?

Professional Development

Does Not
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Competency
Seldom
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Competency
Sometimes
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Competency
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Competency
  1. Encourages employees to take courses relevant to their job.
  1. Contributing fully to the extent of their skills
  1. Allows employees to fully participate in employee training and professional development.
  1. Keep themselves up-to-date of technical/professional issues
  1. Seeks opportunities for professional development.
Please feel free to provide any comments to help explain your answers?

Feedback

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  1. Focus on specific behaviors or actions rather than general comments.
  1. Facilitates effective feedback between managers and their employees.
  1. Willing to listen and consider feedback from colleagues, supervisors, and other stakeholders.
  1. Consistently reviews work achievements in relation to defined goals and criteria, recognizing areas for potential improvement.
  1. Continuously evaluates work performance against established goals and standards, identifying areas where improvements can be made.
Please feel free to provide any comments to help explain your answers?

Persuasion and Influence

Does Not
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Competency
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Competency
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  1. Identifies decision-making inflection points and plans interventions that shape outcomes without forcing consensus.
  1. Convinces department employees of the soundness of a strategic plan.
  1. Overcomes employees' resistance to change and action.
  1. Able to influence others to meet certain goals.
  1. Listens actively and adapts messaging to resonate with different viewpoints without diluting the core message.
Please feel free to provide any comments to help explain your answers?

Action

Does Not
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Competency
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Competency
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  1. Is the first to volunteer for assignments.
  1. Converts plans into actions.
  1. Focuses on tasks without being distracted.
  1. Conducts critical-incident review immediately after the event.
  1. Is proactive in addressing the needs of the department.
Please feel free to provide any comments to help explain your answers?

Bias for Action

Does Not
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Competency
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Competency
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Competency
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  1. Concentrates on tasks single-mindedly until complete.
  1. Overcomes obstacles in pursuit of goals.
  1. Divides large tasks into smaller more manageable steps to maintain momentum.
  1. Projects a can-do attitude that, within the department, is contagious.
  1. Focuses on what matters most and allocate time and resources effectively.
Please feel free to provide any comments to help explain your answers?

Delegation

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Competency
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Competency
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  1. Clearly defines roles, responsibilities, and autonomy to avoid ambiguity.
  1. Encourages employee self-assessment to better understand where preferred tasks and work styles would be most effective.
  1. Ensures that delegated tasks fit within a broader strategic plan.
  1. Balances employee skill level with opportunities for professional development in task assignments.
  1. Knows what employees excel at and what interests them in their work.
Please feel free to provide any comments to help explain your answers?

Change Management

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  1. Understands the consequences that may result from significant changes.
  1. Ensures high quality information is used to implement and/or adjust the changes.
  1. Ensures that employees and teams comply with the recent changes.
  1. Leverages the experience and clout of senior leadership to be advocates for change.
  1. Empowers employees with decision-making responsibilities to allow them to take ownership of certain aspects of the change.
Please feel free to provide any comments to help explain your answers?

Juggling Multiple Responsibilities

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Competency
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Competency
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  1. Spends the most time and effort on critical tasks first.
  1. Organizes tasks for the most efficient order of completion.
  1. Coordinates the work of a team by assigning tasks to other team members.
  1. Ranks the importance of tasks to make sure critical tasks are completed first.
  1. Builds in extra time in the schedule for unplanned events/occurrences.
Please feel free to provide any comments to help explain your answers?

Objectives

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Competency
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Competency
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  1. Works toward achieving established goals and objectives.
  1. Effectively organizes resources and plans
  1. Consistently provides me with timely feedback for improving my performance.
  1. Ability to establish realistic goals.
  1. Establishes goals and objectives.
Please feel free to provide any comments to help explain your answers?

Conflict Management

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  1. Uses structured frameworks or models (e.g., interest-based negotiation, root cause analysis) to guide conflict resolution.
  1. Uses conflict as a springboard for leadership development, helping individuals grow in resilience, empathy, and influence.
  1. Able to persuade and influence others.
  1. Identifies areas of agreement and common ground to form basis of resolution.
  1. Helps team members reframe conflict as an indicator for needed change, rather than a disruption to be avoided.
Please feel free to provide any comments to help explain your answers?

Teamwork

Does Not
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Competency
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Competency
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  1. Builds a strong rapport with team members.
  1. Acts as an effective team player
  1. Recognizes and respects the contributions and needs of each individual.
  1. Works with other team members to achieve objectives.
  1. Builds strong relationships with team members.
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.