Commitment to Result - 360 Degree Feedback Survey Sample #8

Questionnaires Measuring Commitment to Results:
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

You have been selected to complete a self-assessment questionnaire as part of a 360-degree feedback assessment. 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.

Respond to the assessment form based on your work experiences during the previous 12 months. Your responses will be merged with other people's feedback and presented to you in your on-going development. Comments from others will be shared anonymously, as written.

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 .

Commitment To Result

Agree Unsure Disagree N/A
  1. You maintain persistence and dedication to achieving results.
  1. You convey strong sense of own pride in Company to associates by creating a shared vision around sales and customer service.
  1. You are able to focus on a task even when working alone.
  1. You coordinate all department activities into a cohesive team effort.
  1. You are committed to the team.

Establishing Focus/Direction

Agree Unsure Disagree N/A
  1. You stay focused even when under pressure and stress.
  1. You make sure that employees understand and identify with the team's mission.
  1. You align the department's goals with the goals of the organization.
  1. You set appropriate goals for employees.
  1. You maintain focus when handling several problems or tasks simultaneously.

Strategic Focus

Agree Unsure Disagree N/A
  1. You create plans to develop and promote organizational and area strengths, as well as to address weaknesses.
  1. You sustain or achieves a competitive advantage for the organization by analyzing the best practices and lessons learned from other organizations.
  1. You are able to decline a poor strategy by proposing alternate strategies.
  1. You understand and contribute to development of strategic goals.
  1. You communicate goals and objectives to employees.


Agree Unsure Disagree N/A
  1. You adapt to new organizational structures, policies, or procedures.
  1. You identify new opportunities to achieve goals
  1. You encourage others to adopt new procedures.
  1. You are willing to try new ideas.
  1. You act decisively in frequently changing and uncertain environment.

Passion To Learn

Agree Unsure Disagree N/A
  1. You enhance your value to the company through additional training and development.
  1. You take advantage of training opportunities when they arise.
  1. You demonstrate through personal behavior the commitment to high standards of performance.
  1. You hold self and associates accountable for goal achievement.
  1. You embrace new technology and procedures.

Cultural Awareness

Agree Unsure Disagree N/A
  1. You engage with individuals that have different cultural backgrounds.
  1. You foster a diverse workforce free from discrimination and harassment.
  1. You treat others with dignity and respect.
  1. I participate in cultural training sessions/classes.
  1. I function effectively within various cultural contexts.

Administrative Skill

Agree Unsure Disagree N/A
  1. You take responsibility for decisions.
  1. You have strong technical/computer skills.
  1. You implement and use performance measures.
  1. You complete reports on-time.
  1. You are able to develop, justify and present a budget.


Agree Unsure Disagree N/A
  1. You foster a creative and innovative work environment.
  1. You offer constructive improvements to existing systems.
  1. You search for opportunities and innovative ways to improve the organization.
  1. You create improved methods or solutions for meeting goals and objectives.
  1. You build upon the ideas and solutions of others.


Agree Unsure Disagree N/A
  1. You encourage others to take on greater responsibility.
  1. You effectively organize resources and plans
  1. You assure [Company] principles are understood, employed & pursued.
  1. You work toward achieving established goals and objectives.
  1. You communicate goals and objectives to employees.

Empowering Others

Agree Unsure Disagree N/A
  1. You ensure employees understand what is being assigned to them.
  1. You encourage others to obtain necessary skills and training.
  1. You let employees make their own decisions.
  1. You allow individuals to be responsible for their decisions.
  1. You set clear goals for others to accomplish.


Agree Unsure Disagree N/A
  1. You create the conditions for partnerships to grow and develop.
  1. You build alliances between departments and teams.
  1. You partner with peers to obtain influence within the Company.
  1. You support a partnering/networking culture.
  1. You support and encourage relationships that are created by diverse team members.


Agree Unsure Disagree N/A
  1. You seek and utilize mentors to help guide your professional development.
  1. You have a strategic awareness on how to promote the organization.
  1. You encourage risk taking for developing potential business opportunities.
  1. You find unique ways to go around barriers to success.
  1. You are comfortable operating in an environment of uncertainty.

  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.