Delegation - 360 Degree Feedback Survey Sample #9

360 Feedback Survey

Questionnaires Measuring Delegation:
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.


Definite Strength Meets Standards Needs Development N/A
  1. Allows employees to decide how they wish to complete the tasks.
  1. Defines the roles, responsibilities, required actions, and deadlines for team members.
  1. Clearly defines duties and tasks to be completed.
  1. Encourages and empowers subordinates to use initiative in achieving goals and objectives.
  1. Sets clear and reasonable expectations for others and follows through on their progress.

Time Management

Definite Strength Meets Standards Needs Development N/A
  1. Does not procrastinate.
  1. Completes high-priority work within required timelines.
  1. Keeps and maintains a To-Do list.
  1. Avoids distractions in the workplace.
  1. Does not become flustered by deadlines and timelines.


Definite Strength Meets Standards Needs Development N/A
  1. Keeps supervisor informed of recent events.
  1. Takes ownership of mistakes and learns from them.
  1. Defines roles, rights, and responsibilities of the team.
  1. Creates a consistent process for prioritizing work.
  1. Takes responsibility for results.

Continual Learning

Definite Strength Meets Standards Needs Development N/A
  1. Improves on their skill sets.
  1. Participates in regular training offered.
  1. Takes the initiative to learn new skills.
  1. Shares best practices with others and learns from others.
  1. Builds on their strengths while addressing their weaknesses.

Emotional Intelligence

Definite Strength Meets Standards Needs Development N/A
  1. Accurately perceives the emotional reactions of others.
  1. Is able to express themselves clearly.
  1. Helps to make decisions and solve problems using knowledge about how others will react in certain situations.
  1. Is attentive to emotional cues and interprets others' feelings correctly.
  1. Able to understand others' points of view.

Managing Performance

Definite Strength Meets Standards Needs Development N/A
  1. Is consistent in disciplinary/corrective actions.
  1. Sets specific and measurable goals for others and follows through to completion.
  1. Measures performance against goals and objectives.
  1. Sets and maintains high standards for self and others.
  1. Reviews job performance shortly after completion of tasks.

Results Oriented

Definite Strength Meets Standards Needs Development N/A
  1. Explains the "whys" behind organizational objectives
  1. Stays focused on meeting the needs of customers.
  1. Demonstrates the personal confidence to "stay the course," even when faced with difficulty
  1. Works toward achievement of goals even when confronted with obstacles.
  1. Encourages a high-energy, fun work environment and coaches others on how to do the same


Definite Strength Meets Standards Needs Development N/A
  1. Develops a strong safety culture.
  1. Is not afraid to question a potential safety issue observed in the workplace.
  1. Committed to safety in the workplace.
  1. Identifies predictable hazards in the workplace.
  1. Works to implement corrective safety measures.


Definite Strength Meets Standards Needs Development N/A
  1. Coaches employees in how to strengthen knowledge and skills to improve work performance.
  1. Develops the skills and capabilities of others.
  1. Addresses employee behavior problems effectively.
  1. Helps employees to maintain high personal standards.
  1. Meets regularly with employees to coach them on areas that will enhance their performance

  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.