Continual Learning - 360 Degree Feedback Survey Sample #8

Questionnaires Measuring Continual Learning:
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 .

Continual Learning

Agree Unsure Disagree N/A
  1. You set relevant learning objectives and goals.
  1. You grasp new ideas, concepts, technical, or business knowledge.
  1. You build on your strengths while addressing your weaknesses.
  1. I view setbacks as opportunities to learn from.
  1. You pursue professional development opportunities when they arise.

Cultural Awareness

Agree Unsure Disagree N/A
  1. You understand the impact that your culture may have on interactions between individuals.
  1. I develop skills and attitudes to bridge cultural differences.
  1. You are willing to work with employees who have different cultural backgrounds.
  1. You avoid referring to stereotypes about others from different cultures.
  1. I am aware of differences in how individuals from other cultures greet one another.


Agree Unsure Disagree N/A
  1. You make sure goals and objectives are clearly and thoroughly explained and understood.
  1. You provide a clear vision for the future.
  1. You clearly explains responsibilities to individuals.
  1. You avoid stating unclear or conflicting goals.
  1. You clearly explain the vision and goals of the company.


Agree Unsure Disagree N/A
  1. You consult with other partners on issues.
  1. You respect other group/team members.
  1. You work to create innovative ideas from the collaboration with others.
  1. You create an environment that encourages information sharing.
  1. You define shared goals with the committee members.


Agree Unsure Disagree N/A
  1. You address employee behavior problems effectively.
  1. You conduct regular performance appraisals and feedback.
  1. You provide clear, motivating, and constructive feedback.
  1. You develop the skills and capabilities of others.
  1. You meet regularly with employees to coach them on areas that will enhance your performance


Agree Unsure Disagree N/A
  1. You partner with peers to obtain influence within the Company.
  1. You create value within the Company by building networks.
  1. You support and encourage relationships that are created by diverse team members.
  1. You promote the understanding of how the department affects the organization overall.
  1. You develop a sense of trust in subordinates so they can freely interact and share information with others.


Agree Unsure Disagree N/A
  1. You find unique ways to go around barriers to success.
  1. You are comfortable operating in an environment of uncertainty.
  1. You balance risks and rewards when making decisions.
  1. You maintain a high level of energy to respond to demands of the job.
  1. You understand the processes and various stages of business development.


Agree Unsure Disagree N/A
  1. You clearly articulate a vision for your work and inspires others to support it
  1. You behave in a way that is consistent with business values & code of conduct
  1. You express the Company vision in a way that is easily understood and adopted by employees.
  1. You communicate the vision and strategy of [Company]
  1. You develop action plans to align your work with the goals of the organization

  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.