Feedback - 360 Degree Feedback Survey Sample #10

360 Feedback Survey

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)

Thank you for providing feedback for the recipient above. As you respond, please draw on your first-hand experience with this individual in the past 12 months. Rate each item using the scale shown. If you don't feel you have enough first-hand information to rate a certain item, please choose the Not Applicable option. Comments can be very helpful; at a minimum where you give a particularly high or low rating, please share your reasons in the comment section for that competency. Your responses will be compiled with feedback from others and presented to the recipient to help guide their ongoing development.

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.


  • Actively seeks feedback from others.
  • Seeks feedback to enhance performance.
  • Accepts the views of others.
  • Considers other's opinion and suggestions.
  • Asks others for their ideas and opinions.
If [Participant Name] were to make improvements in Feedback, what are your suggestions for how he/she can improve this?

Problem Solving

  • Able to balance the needs of different people in a solution to a problem.
  • Works cooperatively with others to solve problems.
  • Is a good problem solver and decision maker
  • Effective in solving problems.
  • Ability to solve problems at root cause rather than at symptom level.
If [Participant Name] were to make improvements in Problem Solving, what are your suggestions for how he/she can improve this?

Juggling Multiple Responsibilities

  • Recognizes and responds to product placement and signing needs while staying alert to customers' needs, store activities and training associates.
  • Assesses current capabilities before committing to new requests from customers.
  • Integrates developing others with driving sales, serving customers, merchandising, performing operational procedures, and maintaining an appealing store environment.
  • Observes, analyzes, and responds to merchandise needs while serving customers and accomplishing operational tasks.
  • Bounces back from daily crisis, disappointments and frustrations.
If [Participant Name] were to make improvements in Juggling Multiple Responsibilities, what are your suggestions for how he/she can improve this?


  • Establishes relationships of trust, honesty, fairness, and integrity.
  • Follows tasks to completion.
  • Fosters an environment built upon trust.
  • Fosters a high standard of ethics and integrity.
  • Protects the integrity and confidentiality of information
If [Participant Name] were to make improvements in Integrity, what are your suggestions for how he/she can improve this?


  • Researches the needs of the other party to identify strengths and weaknesses of positions.
  • Able to adapt to changing situations.
  • Conducts necessary preparations before engaging in negotiations.
  • Changes communication styles to meet the listener's needs.
  • Able to clearly express thoughts and concerns.
If [Participant Name] were to make improvements in Negotiation, what are your suggestions for how he/she can improve this?
Overall, please rate the effectiveness of [Participant Name Here].


Areas for Development

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