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)

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.

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. Asks others for their ideas and opinions.
  1. Shares past experiences with others as learning opportunities.
  1. Accepts the views of others.
  1. Is visible and approachable.
  1. Is easy to approach with ideas and opinions.

Continual Learning

Agree Unsure Disagree N/A
  1. Shares best practices with others and learns from others.
  1. Pursues self-improvement through continual learning.
  1. Sets relevant learning objectives and goals.
  1. Builds on their strengths while addressing their weaknesses.
  1. Grasps new ideas, concepts, technical, or business knowledge.

Professional Development

Agree Unsure Disagree N/A
  1. Encourages employees to take courses relevant to their job.
  1. Quickly acquire and apply new knowledge and skills when needed
  1. Demonstrate enthusiasm and a willingness to learn new skills and knowledge
  1. Seeks opportunities for professional development.
  1. Contributing fully to the extent of their skills


Agree Unsure Disagree N/A
  1. Makes you feel enthusiastic about your work
  1. Takes responsibility for things that go wrong
  1. Sets an example for others to follow
  1. Delegate tasks effectively
  1. Is ready to offer help

Persuasion and Influence

Agree Unsure Disagree N/A
  1. Persuades others to consider alternative points of view.
  1. Attempts to persuade others rather than simply control them.
  1. Able to express own goals and needs.
  1. Has excellent influencing/negotiating skills.
  1. Communicates effectively with others.


Agree Unsure Disagree N/A
  1. Offers constructive improvements to existing systems.
  1. Implements best practices within the department.
  1. Suggests new ideas at meetings.
  1. Analyzes current procedures and identifies opportunities for improvement.
  1. Builds upon the ideas and solutions of others.


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

Interpersonal Skills

Agree Unsure Disagree N/A
  1. Able to work with individuals at all levels of the Company.
  1. Adapts management style to meet the needs of the individual or situation.
  1. Strives for win/win solutions
  1. Provides constructive feedback in a way that fosters acceptance and development.
  1. Applies appropriate communication techniques to the situation.


Agree Unsure Disagree N/A
  1. Is able to decline bad ideas to avoid making poor decisions.
  1. Influences others through rational argument and persuasion.
  1. Able to say "no" when it is essential to maintaining quality and high standards.
  1. Resolves difficult negotiations whether it is a contract, sub contract, legal or any other difficult negotiation fairly and reasonably.
  1. Able to say "no" when necessary to effectively execute business strategy and meet long-term objectives.

Strategic Focus

Agree Unsure Disagree N/A
  1. Creates plans to develop and promote organizational and area strengths, as well as to address weaknesses.
  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. Sustains or achieves a competitive advantage for the organization by analyzing the best practices and lessons learned from other organizations.


Agree Unsure Disagree N/A
  1. Able to identify the needs of the department before a major change.
  1. Works in an organized manner
  1. Able to look ahead (beyond the present) when addressing the work/needs of the department.
  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 .

  2. Strengths

  3. Areas for Development

  4. Please give any final comments or suggestions for 's assessment.