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 convey strong sense of own pride in Company to associates by creating a shared vision around sales and customer service.
  1. You encourage commitment in others to obtain results.
  1. You are committed to the team.
  1. You take immediate action toward goals.
  1. You are able to focus on a task even when working alone.

Establishing Focus/Direction

Agree Unsure Disagree N/A
  1. You are excellent at managing time.
  1. You maintain focus when handling several problems or tasks simultaneously.
  1. You make sure that employees understand how their work relates to organizational goals.
  1. You align the department's goals with the goals of the organization.
  1. You function well under stress, deadlines, and/or significant workloads.

Strategic Focus

Agree Unsure Disagree N/A
  1. You focus attention on treating the causes of problems rather than simply addressing the symptoms.
  1. You are able to decline a poor strategy by proposing alternate strategies.
  1. You communicate goals and objectives to employees.
  1. You monitor performance of each market within the Area, utilizing reports to ensure sales growth, cost management, and profitability targets are met.
  1. You create plans to develop and promote organizational and area strengths, as well as to address weaknesses.


Agree Unsure Disagree N/A
  1. You identify new opportunities to achieve goals
  1. You are open to the perspectives/viewpoints of others.
  1. You adapt to new organizational structures, policies, or procedures.
  1. You are open to alternative ways to accomplish goals
  1. You adapt to circumstances as needed.

Passion To Learn

Agree Unsure Disagree N/A
  1. You demonstrate a willingness to participate in continuing education courses.
  1. You embrace new technology and procedures.
  1. You exhibit willingness to upgrade skills through additional training and education.
  1. You take initiative for own learning and development.
  1. You enhance your value to the company through additional training and development.

Cultural Awareness

Agree Unsure Disagree N/A
  1. You encourage a work environment where individual differences are valued.
  1. You maintain an inclusive work environment that maximizes the talents of others in achieving goals.
  1. You value the opinions of diverse groups and individual.
  1. You foster a diverse workforce free from discrimination and harassment.
  1. You show respect in daily interactions

Administrative Skill

Agree Unsure Disagree N/A
  1. You have a high attention to detail.
  1. You accurately implement contract provisions.
  1. You are enthusiastic about taking on challenging projects.
  1. You complete reports on-time.
  1. You have strong organizational skills to keep the workspace and department in order


Agree Unsure Disagree N/A
  1. You create improved methods or solutions for meeting goals and objectives.
  1. You implement best practices within the department.
  1. You find creative ways to get things done with limited resources.
  1. You encourage open communication to ensure that all proposals are considered.
  1. You offer constructive improvements to existing systems.


Agree Unsure Disagree N/A
  1. You communicate goals and objectives to employees.
  1. You assure [Company] principles are understood, employed & pursued.
  1. You establish goals and objectives.
  1. You are able to establish realistic goals.
  1. You effectively organize resources and plans

Empowering Others

Agree Unsure Disagree N/A
  1. You let employees complete tasks according to their methods.
  1. You support the decisions of others.
  1. You provide support and resources needed to accomplish goals.
  1. You express confidence in the abilities of others.
  1. You give responsibility for making important decisions to employees.


Agree Unsure Disagree N/A
  1. You create the conditions for partnerships to grow and develop.
  1. You forge mutually beneficial relationships between individuals with diverse backgrounds.
  1. You create value within the Company by building networks.
  1. You seek an understanding of diverse functions within the Company.
  1. You support and encourage relationships that are created by diverse team members.


Agree Unsure Disagree N/A
  1. You encourage risk taking for developing potential business opportunities.
  1. You understand the processes and various stages of business development.
  1. You encourage dynamic growth opportunities.
  1. You maintain a high level of energy to respond to demands of the job.
  1. You balance risks and rewards when making decisions.

  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.