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Feedback - 360 Degree Feedback Survey Sample #2





Questionnaires Measuring Feedback:
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)
Instructions

You have been selected to provide feedback on the employee listed above. Your 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 working with this employee over the last twelve months and the goals they 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 be discussed with the employee to foster growth and on-going development.

Competencies Included:
Feedback, Leadership, Persuasion and Influence, Creativity, Self Management, Passion To Learn, Delegation, Clarity, Company, Fiscal Management
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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Feedback

Clear
Strength
Capable
and
Effective
Could
Benefit from
Development
Needs
Significant
Improvement
  1. Is visible and approachable.
  1. Shares past experiences with others as learning opportunities.
  1. Open to the suggestions of others.
  1. Is easy to approach with ideas and opinions.
  1. Asks others for their ideas and opinions.
What are your suggestions for how [Participant Name] can make improvements
in Feedback?

Leadership

Clear
Strength
Capable
and
Effective
Could
Benefit from
Development
Needs
Significant
Improvement
  1. Effectively leads others.
  1. Highly effective supervisor.
  1. Motivates others to reach and exceed organizational goals and objectives.
  1. Sets a high level of performance expectations and challenges others to do the same.
  1. Sets specific, measurable, and challenging goals.
What are your suggestions for how [Participant Name] can make improvements
in Leadership?

Persuasion and Influence

Clear
Strength
Capable
and
Effective
Could
Benefit from
Development
Needs
Significant
Improvement
  1. Able to express own goals and needs.
  1. Has excellent influencing/negotiating skills.
  1. Communicates effectively with others.
  1. Seeks to obtain consensus or compromise.
  1. Persuades others to consider alternative points of view.
What are your suggestions for how [Participant Name] can make improvements
in Persuasion and Influence?

Creativity

Clear
Strength
Capable
and
Effective
Could
Benefit from
Development
Needs
Significant
Improvement
  1. Adds value to the department/organization.
  1. Creates a lot of new ideas.
  1. Is creative.
  1. Develops solutions to challenging problems.
  1. Is creative and inspirational.
What are your suggestions for how [Participant Name] can make improvements
in Creativity?

Self Management

Clear
Strength
Capable
and
Effective
Could
Benefit from
Development
Needs
Significant
Improvement
  1. Uses patience and self-control in working with customers and associates.
  1. Sets an example for associates during stressful periods by maintaining a positive, can-do attitude.
  1. Does not allow own emotions to interfere with the performance of others.
  1. Is aware of personal impact on others and adjusts behavior to create a positive leadership presence.
  1. Consciously controls own negative emotions in order to keep team morale up.
What are your suggestions for how [Participant Name] can make improvements
in Self Management?

Passion To Learn

Clear
Strength
Capable
and
Effective
Could
Benefit from
Development
Needs
Significant
Improvement
  1. Enhances value to the company through additional training and development.
  1. Embraces new technology and procedures.
  1. Enjoys learning new skills and techniques.
  1. Demonstrates through personal behavior the commitment to high standards of performance.
  1. Demonstrates a willingness to participate in continuing education courses.
What are your suggestions for how [Participant Name] can make improvements
in Passion To Learn?

Delegation

Clear
Strength
Capable
and
Effective
Could
Benefit from
Development
Needs
Significant
Improvement
  1. Clearly defines duties and tasks to be completed.
  1. Delegates authority and responsibility to subordinates and holds them accountable for their actions.
  1. Entrusts subordinates with important tasks.
  1. Assigns tasks to create learning opportunities for the employees.
  1. Allows subordinates to use their own methods and procedures.
What are your suggestions for how [Participant Name] can make improvements
in Delegation?

Clarity

Clear
Strength
Capable
and
Effective
Could
Benefit from
Development
Needs
Significant
Improvement
  1. Is clear about the roles and duties of team members.
  1. Makes sure goals and objectives are clearly and thoroughly explained and understood.
  1. Checks details thoroughly.
  1. Clearly explains the vision and goals of the company.
  1. Clearly explains responsibilities to individuals.
What are your suggestions for how [Participant Name] can make improvements
in Clarity?

Company

Clear
Strength
Capable
and
Effective
Could
Benefit from
Development
Needs
Significant
Improvement
  1. Follows existing procedures and processes.
  1. Understands the "basics" as to how [Company] functions/operates.
  1. Understands the use of [Company] products and services.
  1. Understands how decisions impact other business units beyond their immediate department of work group.
  1. Impresses upon others the important aspects of [Company].
What are your suggestions for how [Participant Name] can make improvements
in Company?

Fiscal Management

Clear
Strength
Capable
and
Effective
Could
Benefit from
Development
Needs
Significant
Improvement
  1. Monitors spending.
  1. Monitors expenses and verifies the need for items purchased.
  1. Effectively manages appropriations, reporting, purchases, expenditures, payrolls, and staff.
  1. Keeps excellent records for financial transparency.
  1. Develops budgets and plans for various programs and initiatives.
What are your suggestions for how [Participant Name] can make improvements
in Fiscal Management?


  1. Strengths


  2. Areas for Development


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