Delegation - 360 Degree Feedback Survey Sample #10

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.


  • Defines goals and objectives for subordinates.
  • Tells subordinates what to do, not how to do it.
  • Assigns tasks to create learning opportunities for the employees.
  • Allows subordinates to use their own methods and procedures.
  • Encourages and empowers subordinates to use initiative in achieving goals and objectives.
If [Participant Name] were to make improvements in Delegation, what are your suggestions for how he/she can improve this?


  • Prioritizes various actions to be taken when solving a problem.
  • Identifies opportunities for progress and innovation.
  • Identifies the root cause of a problem.
  • Selects the appropriate techniques for analysis.
  • Identifies problems and issues needing resolution.
If [Participant Name] were to make improvements in Analytical, what are your suggestions for how he/she can improve this?

Client Focus

  • Is pro-active in dealing with clients and addressing their needs.
  • Looks for opportunities that have a positive impact on Clients.
  • Satisfies client needs.
  • Obtains feedback to ensure client needs are being met.
  • Maintains strong relationships with clients.
If [Participant Name] were to make improvements in Client Focus, what are your suggestions for how he/she can improve this?

Self Management

  • Is aware of personal impact on others and adjusts behavior to create a positive leadership presence.
  • Uses patience and self-control in working with customers and associates.
  • Sets an example for associates during stressful periods by maintaining a positive, can-do attitude.
  • Steps away from a situation to process appropriate response.
  • Analyzes interpersonal problems instead of reacting to them.
If [Participant Name] were to make improvements in Self Management, what are your suggestions for how he/she can improve this?


  • Recognizes individuals for a specific outstanding achievement.
  • Compliments other people when they do good work
  • Recognizes the abilities and skills of self and others
  • Finds opportunities to recognize others.
  • Is sincerely interested in the suggestions of co-workers
If [Participant Name] were to make improvements in Recognition, 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.