Communication - 360 Degree Feedback Survey Sample #9

360 Feedback Survey

Questionnaires Measuring Communication:
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.

Sample Result Document:
Sample Results
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.

Communication Skills

Definite Strength Meets Standards Needs Development N/A
  1. Is an effective communicator
  1. Communicates effectively with colleagues and customers
  1. Addresses issues of key importance to stakeholders.
  1. Communications with department leadership
  1. Conveys ideas confidently and succinctly.


Definite Strength Meets Standards Needs Development N/A
  1. Open to the perspectives/viewpoints of others.
  1. Adapts to new organizational structures, policies, or procedures.
  1. Effective in incorporating new ideas.
  1. Is open to alternative ways to accomplish goals
  1. Willing to try new ideas.

Bias for Action

Definite Strength Meets Standards Needs Development N/A
  1. Seeks and utilizes opportunities for continuous learning and self-development.
  1. Projects a "can-do" attitude when interfacing with peers, subordinates and customers(especially during difficult and challenging times).
  1. Completes work on time
  1. Motivates others to achieve or exceed goals
  1. Conveys a sense of urgency about addressing problems and opportunities

Emotional Intelligence

Definite Strength Meets Standards Needs Development N/A
  1. Is able to manage their own emotions.
  1. Is attentive to emotional cues and interprets others' feelings correctly.
  1. Is able to control their own emotions.
  1. Accurately perceives the emotional reactions of others.
  1. Helps to make decisions and solve problems using knowledge about how others will react in certain situations.


Definite Strength Meets Standards Needs Development N/A
  1. Delegate tasks effectively
  1. Is ready to offer help
  1. Takes responsibility for things that go wrong
  1. Makes you feel enthusiastic about your work
  1. Sets an example for others to follow

Problem Solving

Definite Strength Meets Standards Needs Development N/A
  1. Implements effective solutions to critical problems.
  1. Generates alternative solutions to problems and challenges.
  1. Identifies and assesses all potential responses to a problem.
  1. Understands the root causes of problems.
  1. Effective in solving problems.

Change Management

Definite Strength Meets Standards Needs Development N/A
  1. Adopts changes to set and example for others to follow.
  1. Assists others in understanding changes to the organization.
  1. Effective in dealing with ambiguous and challenging situations.
  1. Effective in implementing new organizational vision and values.
  1. Supports the Company's efforts to implement changes.

Commitment To Result

Definite Strength Meets Standards Needs Development N/A
  1. Encourages commitment in others to obtain results.
  1. Committed to the team.
  1. Able to focus on a task even when working alone.
  1. Creates a sense of urgency among the store team members to complete activities, which drive sales.
  1. Conveys strong sense of own pride in Company to associates by creating a shared vision around sales and customer service.

Technology Use/Management

Definite Strength Meets Standards Needs Development N/A
  1. Supports employee training and development initiatives regarding implementation of technology.
  1. Adopts the implementation of new technology into the workplace.
  1. Understands and is committed to implementing new technologies.
  1. Proficient in the use of technical systems and processes.
  1. Identifies gaps between actual and needed technical competencies and provides recommendations for required training.


Definite Strength Meets Standards Needs Development N/A
  1. ...takes personal responsibility for results.
  1. Sets a good example
  1. Sets high personal standards of performance.
  1. Holds herself / himself accountable to goals / objectives
  1. Responsible for setting the vision of the department.

Organizational Fluency

Definite Strength Meets Standards Needs Development N/A
  1. Gets things done through the department.
  1. Understands departmental policies and procedures.
  1. Able to deal with sensitive issues with tact and professionalism.
  1. Effective in communicating with others within the organization.
  1. Adept at navigating within the culture of the department.

  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.