Commitment to Result - 360 Degree Feedback Survey Sample #10

360 Feedback Survey

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)

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.

Commitment To Result

  • Conveys strong sense of own pride in Company to associates by creating a shared vision around sales and customer service.
  • Maintains persistence and dedication to achieving results.
  • Takes immediate action toward goals.
  • Able to focus on a task even when working alone.
  • Committed to the team.
If [Participant Name] were to make improvements in Commitment To Result, what are your suggestions for how he/she can improve this?


  • Fosters a high standard of ethics and integrity.
  • Protects the integrity and confidentiality of information
  • Maintains strong relationships with others.
  • Fosters an environment built upon trust.
  • Establishes relationships of trust, honesty, fairness, and integrity.
If [Participant Name] were to make improvements in Integrity, what are your suggestions for how he/she can improve this?

Cultural Awareness

  • Engages with individuals that have different cultural backgrounds.
  • Interacts effectively with people from different cultural backgrounds.
  • Is willing to include individuals with different cultural backgrounds on the team.
  • Effective in working with individuals with a variety of cultural backgrounds.
  • Willing to work with employees who have different cultural backgrounds.
If [Participant Name] were to make improvements in Cultural Awareness, what are your suggestions for how he/she can improve this?


  • Is a highly effective supervisor.
  • Gives direct, constructive, and actionable feedback.
  • Effectively leads others.
  • Clearly explains performance expectations and goals to be reached at the beginning of a project, then let's others decide how to achieve the goal.
  • Holds others accountable for their actions.
If [Participant Name] were to make improvements in Leadership, what are your suggestions for how he/she can improve this?

Fiscal Management

  • Develops of the department's annual budget.
  • Keeps excellent records for financial transparency.
  • Monitors expenses and verifies the need for items purchased.
  • Effectively manages appropriations, reporting, purchases, expenditures, payrolls, and staff.
  • Ensures others follow the correct rules and regulations on fiscal matters.
If [Participant Name] were to make improvements in Fiscal Management, 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.