Company- 360 Degree Feedback Survey Sample #10

360 Feedback Survey

Assessments Measuring Company:
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.


  • Understands the "basics" as to how [Company] functions/operates.
  • Attends [Company] gatherings and social events.
  • Understands how decisions impact other business units beyond their immediate department of work group.
  • Expresses loyalty and dedication to [Company] in interactions with others.
  • Impresses upon others the important aspects of [Company].
If [Participant Name] were to make improvements in Company, what are your suggestions for how he/she can improve this?

Change Management

  • Effective in implementing new organizational vision and values.
  • Assists others in understanding changes to the organization.
  • Supports the Company's efforts to implement changes.
  • Works cooperatively with others to implement changes.
  • Adopts changes to set and example for others to follow.
If [Participant Name] were to make improvements in Change Management, what are your suggestions for how he/she can improve this?


  • Is knowledgeable of procedures or systems necessary for the job.
  • Knows how to produce high quality products/work.
  • Seeks information from others as needed.
  • Uses expertise to identify issues and think through creative solutions to get a problem solved or objective accomplished.
  • Demonstrates mastery of the technical competencies required in his/her work.
If [Participant Name] were to make improvements in Technical, what are your suggestions for how he/she can improve this?


  • Supports our company's safety programs.
  • Committed to safety in the workplace.
  • Develops safety guidelines for the department.
  • Works to implement corrective safety measures.
  • Ensures compliance with safety regulations.
If [Participant Name] were to make improvements in Safety, what are your suggestions for how he/she can improve this?


  • Actively participates in the work of teams; seeks and listens to others' contributions
  • Willingly share their technical expertise
  • Actively participates as a team member
  • Is open to new ideas that may change own goals for benefit of the team
  • Creates a climate that encourages team participation.
If [Participant Name] were to make improvements in Teamwork, 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.