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Feedback - 360 Degree Feedback Survey Sample #3





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 asked to evaluate yourself as part of a 360-degree feedback process. Other employees, including your manager(s), peers, and direct reports will also evaluate you. In this manner, you will be provided with a comprehensive, multi-perspective (i.e., 360-degree) view of your performance as a manager. The objective is to provide you with feedback so as to allow you to improve your performance, resulting in improved team performance, and organizational effectiveness.

If you are not able to respond to an item, leave it blank and go on to the next item.

Competencies Included:
Feedback, Attitude, Cultural Awareness, Project Management, Decision Making, Commitment To Result, Professional Development, Technical, Trustworthy, Co-worker Development, Vision
Sample Result Document:
Sample Results
We encourage everyone to complete the survey. Please be honest, constructive and thoughtful in your input. The survey is designed to help us understand more about your thoughts and needs to make this a great company.

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



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Feedback

Does Not
Exhibit this
Competency
Seldom
Exhibits this
Competency
Sometimes
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Competency
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Competency
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Exhibits this
Competency
  1. Open to the suggestions of others.
  1. Shares past experiences with others as learning opportunities.
  1. Looks to others for input.
  1. Asks others for their ideas and opinions.
  1. Considers other's opinion and suggestions.
Please feel free to provide any comments to help explain your answers?

Attitude

Does Not
Exhibit this
Competency
Seldom
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Competency
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Competency
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  1. Contributes to a positive work environment.
  1. Shows by their actions that they trust in the positive intentions of others.
  1. Is gracious and professional in their interactions with others.
  1. Contributes to a positive and fun work environment.
  1. Builds open and trusting relationships.
Please feel free to provide any comments to help explain your answers?

Cultural Awareness

Does Not
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Competency
Seldom
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Competency
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  1. Is willing to include individuals with different cultural backgrounds on the team.
  1. Seeks knowledge and information about other cultures.
  1. Actively listens to other employees' stories about their culture.
  1. Seeks to reduce obstacles in communication that might arise from cultural differences.
  1. Is curious and willing to ask questions about the cultural differences in the workplace.
Please feel free to provide any comments to help explain your answers?

Project Management

Does Not
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  1. Regularly reviews project performance and goals.
  1. Adds the necessary time buffers to avoid the project getting behind schedule.
  1. Acquires and allocates internal and external resources needed for the project.
  1. Determines the project scope.
  1. Creates the metrics used to measure progress on the project.
Please feel free to provide any comments to help explain your answers?

Decision Making

Does Not
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Competency
Seldom
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Competency
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  1. Makes decisions based on novel interpretations of the facts.
  1. Makes good decisions for the department.
  1. Gathers information before making a decision.
  1. Is aware of the impact of decisions and informs others about potential outcomes.
  1. Examines relevant factors needed to make a decision.
Please feel free to provide any comments to help explain your answers?

Commitment To Result

Does Not
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Competency
Seldom
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Competency
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Competency
  1. Able to focus on a task even when working alone.
  1. Takes immediate action toward goals.
  1. Conveys strong sense of own pride in Company to associates by creating a shared vision around sales and customer service.
  1. Creates a sense of urgency among the store team members to complete activities, which drive sales.
  1. Maintains persistence and dedication to achieving results.
Please feel free to provide any comments to help explain your answers?

Professional Development

Does Not
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  1. Keep themselves up-to-date of technical/professional issues
  1. Seeks opportunities for professional development.
  1. Seeks opportunities for continuous learning.
  1. Allows employees to fully participate in employee training and professional development.
  1. Quickly acquire and apply new knowledge and skills when needed
Please feel free to provide any comments to help explain your answers?

Technical

Does Not
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Competency
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Competency
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Competency
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Competency
  1. Knows how to produce high quality products/work.
  1. Is naturally sought out by people outside his/her particular area for advice and opinion on a broad range of matters - not necessarily solely legal advice.
  1. Demonstrates mastery of the technical competencies required in his/her work.
  1. Willingly shares information and expertise; sought out as resource by others
  1. Willingly shares his/her technical expertise; sought out as resource by others
Please feel free to provide any comments to help explain your answers?

Trustworthy

Does Not
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Competency
Seldom
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Competency
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  1. Demonstrates congruence between statements and actions.
  1. Delivers on promises made.
  1. Works in a way that makes others want to work with her/him.
  1. Consistently keeps commitments.
  1. Seeks to mitigate grievances by clarifying intentions and finding suitable remedies.
Please feel free to provide any comments to help explain your answers?

Co-worker Development

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Competency
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  1. Adapts coaching and mentoring approach to meet the style or needs of individuals
  1. Provides ongoing feedback to co-workers on their development progress
  1. Takes immediate action on poor performance
  1. Sets and clearly communicates expectations, performance goals, and measurements to others
  1. Gives others development opportunities through project assignments and increased job responsibilities
Please feel free to provide any comments to help explain your answers?

Vision

Does Not
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Competency
Seldom
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Competency
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Competency
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  1. Creates strategic initiatives that support the organization's common vision.
  1. Supports a strong employee culture to ensure alignment with the company's vision.
  1. Understands the vision of the Company and promotes it ahead of any self-interests.
  1. Inspires individuals to achieve success by clearly communicating the organization's vision and motivating them to align their personal goals with this vision.
  1. Develops an inspiring and ambitious vision of growth for the organization's future.
Please feel free to provide any comments to help explain your answers?

  1. Overall, please rate the effectiveness of [Participant Name].






  2. Strengths


  3. Areas for Development


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