Commitment to Result - 360 Degree Feedback Survey Sample #11

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.

To what extent does [Participant Name] exhibit the following ...

SELECT the rating that best reflects the employee's performance in the areas listed.

Commitment To Result

What does Commitment To Result mean?
It means that ...
  • You are able to focus on a task even when working alone.
  • You encourage commitment in others to obtain results.
  • You are willing to do whatever it takes-not afraid to have to put in extra effort.
  • You take immediate action toward goals.
  • You coordinate all department activities into a cohesive team effort.

To what extent does this person exhibit Commitment To Result?
Select from one of the ratings below.

Supervisory Skills

What does Supervisory Skills mean?
It means that ...
  • I exemplify professionalism in the workplace.
  • I maintain the confidence and trust of employees.
  • You promote teamwork and cooperation within the department.
  • I maintain a calm demeanor when addressing stressful issues in the workplace.
  • You treat all staff equitably.

To what extent does this person exhibit Supervisory Skills?
Select from one of the ratings below.


What does Quality mean?
It means that ...
  • You hold employees accountable for your quality of work.
  • You always strive to produce the highest quality work products.
  • You analyze what occurred and re-adjusts accordingly when goals are not met.
  • You encourage others to achieve high quality standards.
  • You correct issues in a timely manner.

To what extent does this person exhibit Quality?
Select from one of the ratings below.


What does Company mean?
It means that ...
  • You understand the use of [Company] products and services.
  • You express loyalty and dedication to [Company] in interactions with others.
  • You understand the "basics" as to how [Company] functions/operates.
  • You follow existing procedures and processes.
  • You attend [Company] gatherings and social events.

To what extent does this person exhibit Company?
Select from one of the ratings below.

Self Management

What does Self Management mean?
It means that ...
  • You do not allow own emotions to interfere with the performance of others.
  • You analyze interpersonal problems instead of reacting to them.
  • You step away from a situation to process appropriate response.
  • You use patience and self-control in working with customers and associates.
  • You are aware of personal impact on others and adjusts behavior to create a positive leadership presence.

To what extent does this person exhibit Self Management?
Select from one of the ratings below.

Areas for Development

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