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. Is easy to approach with ideas and opinions.
  1. Open to the suggestions of others.
  1. Looks to others for input.
  1. Considers other's opinion and suggestions.
  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. Takes ownership and accountability for results
  1. Recognizes individual and team accomplishments and reward them appropriately.
  1. Expresses clear goals and objectives.
  1. Gives inspiring presentations or discussions.
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. Attempts to persuade others rather than simply control them.
  1. Ensures stakeholders are involved in the decision making process.
  1. Seeks to obtain consensus or compromise.
  1. Communicates effectively 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. Is creative.
  1. Develops solutions to challenging problems.
  1. Adds value to the department/organization.
  1. Creates a lot of new ideas.
  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. Analyzes interpersonal problems instead of reacting to them.
  1. Is aware of personal impact on others and adjusts behavior to create a positive leadership presence.
  1. Analyzes own reactions on the spot to ensure that communication does not appear to be driven by anger.
  1. Consciously controls own negative emotions in order to keep team morale up.
  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. Enhances value to the company through additional training and development.
  1. Stays up-to-date on emerging technologies.
  1. Creates an environment that supports personal development and exploration.
  1. Holds self and associates accountable for goal achievement.
  1. Demonstrates through personal behavior the commitment to high standards of performance.
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. Delegates authority and responsibility to subordinates and holds them accountable for their actions.
  1. Assigns tasks to create learning opportunities for the employees.
  1. Delegates tasks, responsibilities, and accountability as appropriate to the level of employee.
  1. Defines goals and objectives for subordinates.
  1. Sets clear and reasonable expectations for others and follows through on their progress.
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. Makes sure employees understand why they were given certain assignments.
  1. Is clear about the roles and duties of team members.
  1. Writes clear job descriptions for positions in the organization.
  1. Uses appropriate grammar and tense in communications.
  1. Clarifies problems and their causes to help employees correct them.
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 the use of [Company] products and services.
  1. Understands how decisions impact other business units beyond their immediate department of work group.
  1. Follows existing procedures and processes.
  1. Understands the "basics" as to how [Company] functions/operates.
  1. Attends [Company] gatherings and social events.
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. Ensures others follow the correct rules and regulations on fiscal matters.
  1. Monitors expenses and verifies the need for items purchased.
  1. Develops budgets and plans for various programs and initiatives.
  1. Monitors spending.
  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.