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Excellence - 360 Degree Feedback Survey Sample #2





Questionnaires Measuring Excellence:
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)
Survey 13 (4-point scale; numbers; floating anchors)
Survey 14 (4-point scale; N/A)
Self-Assessment Instructions

You have been asked to complete a self-assessment questionnaire form (shown below). You will also receive feedback from others such as your peers, direct reports and manager. Feedback is an important part of our company's leadership development process and this survey is intended to gather broad feedback in the core competencies and role responsibilities that are important for the on-going success of our organization.

In responding to the questions below, think about your experiences as an employee over the last twelve months and the goals you were asked to achieve. The effectiveness of this development tool is dependent on your honest, forthright and constructive responses so please bear this in mind as you answer each question. Your responses will become part of the assessment process to foster your growth and on-going development.

Competencies Included:
Excellence, Bias for Action, Leadership, Supervisory Skills, Persuasion and Influence, Decision Making, Innovation, Adaptability, Juggling Multiple Responsibilities, Technology Use/Management, Regulatory/Compliance, Client Focus, Teamwork, Strategic Focus
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.

Please ensure that your submission is made between . The survey will only be available during these dates.
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Excellence

Clear
Strength
Capable
and
Effective
Could
Benefit from
Development
Needs
Significant
Improvement
  1. You learn and apply new analytical methods to deepen data interpretation.
  1. I focus on accomplishing meaningful work efficiently and effectively.
  1. I assume broader responsibilities to strengthen expertise and prepare for future leadership roles.
  1. I apply mentor-suggested strategies to improve work process and elevate performance standards.
What are your suggestions for how you can make improvements
in Excellence?

Bias for Action

Clear
Strength
Capable
and
Effective
Could
Benefit from
Development
Needs
Significant
Improvement
  1. I foresee potential obstacles and act preemptively to address them.
  1. You positively motivate and support others to gain skills
  1. You always deliver on promises.
  1. You seek to enhance processes and procedures, even if only a minor change, to make them more efficient.
What are your suggestions for how you can make improvements
in Bias for Action?

Leadership

Clear
Strength
Capable
and
Effective
Could
Benefit from
Development
Needs
Significant
Improvement
  1. You say "no" to ideas that will result in lost time and effort.
  1. I celebrate initiative and recognize employees who take ownership beyond their core responsibilities.
  1. You hold team members accountable to commitments made
  1. I provide employees with the authority and resources need to make decisions within their roles.
What are your suggestions for how you can make improvements
in Leadership?

Supervisory Skills

Clear
Strength
Capable
and
Effective
Could
Benefit from
Development
Needs
Significant
Improvement
  1. I am successful in resolving personnel conflicts.
  1. You offer constructive feedback to facilitate performance improvement.
  1. I maintain disciplinary policies and fair enforcement of work rules
  1. I promote shared accountability by reinforcing that team success depends on collective effort.
What are your suggestions for how you can make improvements
in Supervisory Skills?

Persuasion and Influence

Clear
Strength
Capable
and
Effective
Could
Benefit from
Development
Needs
Significant
Improvement
  1. You build and sustains a strong personal brand grounded in trust, competence, and ethical conduct.
  1. You build influence by consistently showing appreciation for others' contributions.
  1. You build an interpersonal rapport with clients and customers to more successfully persuade them to purchase specific products.
  1. You exhibit good sense and moral character.
What are your suggestions for how you can make improvements
in Persuasion and Influence?

Decision Making

Clear
Strength
Capable
and
Effective
Could
Benefit from
Development
Needs
Significant
Improvement
  1. You skillfully integrate diverse and opposing information sources.
  1. You stay true to your values and ethical standards even when decisions are difficult or unpopular.
  1. You are willing to change your strategy if new information arises.
  1. I am open and flexible using tools to objectively assess and rank alternatives based on weighted criteria.
What are your suggestions for how you can make improvements
in Decision Making?

Innovation

Clear
Strength
Capable
and
Effective
Could
Benefit from
Development
Needs
Significant
Improvement
  1. You guarantee that team members are equipped with the technical expertise needed to excel in innovative projects.
  1. You encourage open communication to ensure that all proposals are considered.
  1. You analyze current procedures and identify opportunities for improvement.
  1. I keep an open mind towards innovative concepts ensuring managers are continuously exploring potential growth avenues.
What are your suggestions for how you can make improvements
in Innovation?

Adaptability

Clear
Strength
Capable
and
Effective
Could
Benefit from
Development
Needs
Significant
Improvement
  1. You are flexible and open minded in dealing with others.
  1. You work effectively in dynamic and changing work environments.
  1. You confront unexpected changes by remaining flexible and adaptable.
  1. I successfully handle the implementation of the reorganization.
What are your suggestions for how you can make improvements
in Adaptability?

Juggling Multiple Responsibilities

Clear
Strength
Capable
and
Effective
Could
Benefit from
Development
Needs
Significant
Improvement
  1. You use a scheduler/planner to keep tasks organized and on time.
  1. You plan and organize continuously while performing all other responsibilities and activities.
  1. You maintain high output during peak periods by streamlining processes and eliminating unnecessary steps.
  1. I delegate recurring or routine tasks to streamline workflow and reduce cognitive load.
What are your suggestions for how you can make improvements
in Juggling Multiple Responsibilities?

Technology Use/Management

Clear
Strength
Capable
and
Effective
Could
Benefit from
Development
Needs
Significant
Improvement
  1. You assess whether existing tools can be enhanced, reconfigured, or better utilized before recommending new investments.
  1. I evaluate operational workflows to determine where technology can meaningfully improve efficiency, accuracy, or throughput.
  1. I ensure employees follow organizational policies for data handling, privacy, and responsible technology use.
  1. I build multi-year technology roadmaps that sequence upgrades, integrations, and capability development.
What are your suggestions for how you can make improvements
in Technology Use/Management?

Regulatory/Compliance

Clear
Strength
Capable
and
Effective
Could
Benefit from
Development
Needs
Significant
Improvement
  1. I review documentation and procedures manuals to ensure regulatory compliance.
  1. I respond accurately and completely to questions from regulators.
  1. I strengthen employees' ability to appropriately handle compliance and ethics issues.
  1. I develop and implement appropriate reporting channels.
What are your suggestions for how you can make improvements
in Regulatory/Compliance?

Client Focus

Clear
Strength
Capable
and
Effective
Could
Benefit from
Development
Needs
Significant
Improvement
  1. I create documents that meet the client's specifications.
  1. I exhibit a positive attitude even when dealing with difficult clients.
  1. You use client feedback to help improve products and services.
  1. I am committed to the client's success.
What are your suggestions for how you can make improvements
in Client Focus?

Teamwork

Clear
Strength
Capable
and
Effective
Could
Benefit from
Development
Needs
Significant
Improvement
  1. I am a role model of commitment to advancing the team's mission.
  1. You facilitate discussions when role boundaries blur, helping the team renegotiate responsibilities before confusion or conflict develops.
  1. You demonstrate an understanding of other team member's viewpoints.
  1. You foster ownership of team objectives to build commitment for the team's success.
What are your suggestions for how you can make improvements
in Teamwork?

Strategic Focus

Clear
Strength
Capable
and
Effective
Could
Benefit from
Development
Needs
Significant
Improvement
  1. You understand how to grow the business and increase customers.
  1. You coordinate the implementation of the strategy with stakeholders.
  1. You strategically position resources to meet the needs of field based employees.
  1. I identify and address strategic risks impacting operations.
What are your suggestions for how you can make improvements
in Strategic Focus?


  1. Strengths


  2. Areas for Development


  3. Please give any final comments or suggestions for [Participant Name Here]'s assessment.