Excellence - 360 Degree Feedback Survey Sample #10

360 Feedback Survey

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)

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.


  • Takes a lot of pride in their work.
  • Demonstrates the functional or technical skills necessary to do their job.
  • Demonstrates the analytical skills to do their job.
  • Keeps themselves and others focused on constant improvement.
  • Produces high quality work.
If [Participant Name] were to make improvements in Excellence, what are your suggestions for how he/she can improve this?


  • Able to adapt to new situations.
  • Acts decisively in frequently changing and uncertain environment.
  • Adapts to new organizational structures, policies, or procedures.
  • Identifies new opportunities to achieve goals
  • Can handle changes without complaining.
If [Participant Name] were to make improvements in Flexibility, what are your suggestions for how he/she can improve this?


  • Demonstrates leadership and courage in critical situations.
  • Takes ownership and accountability for results
  • Able to influence others.
  • Gives direct, constructive, and actionable feedback.
  • Clearly explains performance expectations and goals to be reached at the beginning of a project, then let's others decide how to achieve the goal.
If [Participant Name] were to make improvements in Leadership, what are your suggestions for how he/she can improve this?

Administrative Skill

  • Has strong technical/computer skills.
  • Enthusiastic about taking on challenging projects.
  • High attention to detail.
  • Strong organizational skills to keep the workspace and department in order
  • Completes reports on-time.
If [Participant Name] were to make improvements in Administrative Skill, what are your suggestions for how he/she can improve this?

Customer Focus

  • Considers customers point of view when making decisions.
  • Develops strong customer relationships.
  • Develops good rapport and trust with the customer.
  • Asks questions and listens carefully to determine customer needs and to ensure that the customer's needs are met.
  • Ensures all customer commitments and requirements are met or exceeded.
If [Participant Name] were to make improvements in Customer Focus, 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.