Feedback - 360 Degree Feedback Survey Sample #8

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)

You have been selected to provide feedback for the manager listed above. Your feedback is an important part of 's leadership development process. This tool 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 assessment form, please think about your experiences working with this individual during the last six to twelve months. Your responses will be merged with other people's feedback and presented to to guide them in their on-going development. Comments will be shared anonymously, as written, with the manager.

Sample Result Document:
Sample Results
Method of use: As part of the review process, managers will receive feedback from peers and staff. It is recognized that not all participants will be able to assess an individual's performance in all areas. The feedback received will be utilized as input to the manager's performance and on-going development plan.

You may sign out at any time by pressing the Save button at the end of the form and then closing your browser. You may return later to pick up where you left off. When you are done, press the Complete button.

When clicking your selection below, try to best fit the manager's actual behaviors to the scale provided.

If you are not sure, or unable to assess, select "Not Applicable" (N/A) option.

Please complete your response by .


Agree Unsure Disagree N/A
  1. Looks to others for input.
  1. Actively seeks feedback from others.
  1. Is visible and approachable.
  1. Seeks feedback to enhance performance.
  1. Is easy to approach with ideas and opinions.

Continual Learning

Agree Unsure Disagree N/A
  1. Seeks opportunities to grow in skills and knowledge.
  1. Pursues self-improvement through continual learning.
  1. Pursues professional development opportunities when they arise.
  1. Participates in regular training offered.
  1. Improves on their skill sets.

Professional Development

Agree Unsure Disagree N/A
  1. Seeks opportunities for continuous learning.
  1. Quickly acquire and apply new knowledge and skills when needed
  1. Seeks opportunities for professional development.
  1. Encourages employees to take courses relevant to their job.
  1. Keep themselves up-to-date of technical/professional issues


Agree Unsure Disagree N/A
  1. Makes you feel enthusiastic about your work
  1. Keep staff informed about what is happening in the company
  1. Takes responsibility for things that go wrong
  1. Is ready to offer help
  1. Delegate tasks effectively

Persuasion and Influence

Agree Unsure Disagree N/A
  1. Able to express own goals and needs.
  1. Persuades others to consider alternative points of view.
  1. Attempts to persuade others rather than simply control them.
  1. Ensures stakeholders are involved in the decision making process.
  1. Has excellent influencing/negotiating skills.


Agree Unsure Disagree N/A
  1. Analyzes current procedures and identifies opportunities for improvement.
  1. Finds creative ways to get things done with limited resources.
  1. Builds upon the ideas and solutions of others.
  1. Fosters a creative and innovative work environment.
  1. Creates a safe environment for idea-sharing.


Agree Unsure Disagree N/A
  1. Can be counted on to add value wherever they are involved.
  1. Demonstrates the functional or technical skills necessary to do their job.
  1. Produces high quality work.
  1. Is planful and organized.
  1. Takes a lot of pride in their work.

Interpersonal Skills

Agree Unsure Disagree N/A
  1. Uses knowledge and charisma rather than position, power, or coercion to influence others
  1. Effectively manages conflicts by dealing with them directly and immediately
  1. Adapts management style to meet the needs of the individual or situation.
  1. Builds a strong rapport with co-workers.
  1. Is open and approachable


Agree Unsure Disagree N/A
  1. Able to influence others to accept certain positions.
  1. Able to say "no" when necessary to effectively execute business strategy and meet long-term objectives.
  1. Conducts necessary preparations before engaging in negotiations.
  1. Maintains good interpersonal relationships with representatives from the other party.
  1. Establishes good working relationships with others.

Strategic Focus

Agree Unsure Disagree N/A
  1. Understands their role within the organization.
  1. Looks for opportunities to enhance contributions to the bottom line.
  1. Monitors performance of each market within the Area, utilizing reports to ensure sales growth, cost management, and profitability targets are met.
  1. Understands & contributes to development of strategic goals.
  1. Creates plans to develop and promote organizational and area strengths, as well as to address weaknesses.


Agree Unsure Disagree N/A
  1. Delegates role to team members to accomplish goals.
  1. Able to look ahead (beyond the present) when addressing the work/needs of the department.
  1. Able to identify the needs of the department before a major change.
  1. Anticipates potential challenges, develops plan to overcome them and then carries out the plan.
  1. Anticipates obstacles and ways to overcome them.

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

  2. Strengths

  3. Areas for Development

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