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)
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.


Feedback

Clear
Strength
Capable
and
Effective
Could
Benefit from
Development
Needs
Significant
Improvement
  1. Asks others for their ideas and opinions.
  1. Looks to others for input.
  1. Seeks feedback to enhance performance.
  1. Considers other's opinion and suggestions.
  1. Shares past experiences with others as learning opportunities.
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. Gives direct, constructive, and actionable feedback.
  1. Acts decisively in implementing decisions.
  1. Holds others accountable for their actions.
  1. Recognizes individual and team accomplishments and reward them appropriately.
  1. Guides decision-making by coaching, counseling and rewarding.
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. Seeks to obtain consensus or compromise.
  1. Ensures stakeholders are involved in the decision making process.
  1. Understanding what others need.
  1. Communicates effectively with others.
  1. Develops a good rapport with others.
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. Develops solutions to challenging problems.
  1. Is creative.
  1. Adds value to the department/organization.
  1. Conceives, implements and evaluates ideas.
  1. Inspires creativity in their team.
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. Analyzes interpersonal problems instead of reacting to them.
  1. Consciously controls own negative emotions in order to keep team morale up.
  1. Analyzes own reactions on the spot to ensure that communication does not appear to be driven by anger.
  1. Uses patience and self-control in working with customers and associates.
  1. Deals with conflict by controlling own emotions by listening, being flexible, and sincere in responding.
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. Creates an environment that supports personal development and exploration.
  1. Embraces new technology and procedures.
  1. Will participate in training classes even if offered outside of normal working hours.
  1. Stays up-to-date on emerging technologies.
  1. Is open to feedback from others.
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. Allows subordinates to use their own methods and procedures.
  1. Tells subordinates what to do, not how to do it.
  1. Delegates authority and responsibility to subordinates and holds them accountable for their actions.
  1. Defines the roles, responsibilities, required actions, and deadlines for team members.
  1. Defines goals and objectives for subordinates.
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. Checks details thoroughly.
  1. Avoids stating unclear or conflicting goals.
  1. Provides a clear vision for the future.
  1. Attends to the important details of a job or task.
  1. Avoids creating ambiguity or mixed messages.
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. Understands how decisions impact other business units beyond their immediate department of work group.
  1. Attends [Company] gatherings and social events.
  1. Follows existing procedures and processes.
  1. Expresses loyalty and dedication to [Company] in interactions with others.
  1. Understands the "basics" as to how [Company] functions/operates.
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. Effectively manages appropriations, reporting, purchases, expenditures, payrolls, and staff.
  1. Develops budgets and plans for various programs and initiatives.
  1. Provides budgeting and accounting support to the Company.
  1. Develops of the department's annual budget.
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.