Feedback - 360 Degree Feedback Survey Sample #11

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.

To what extent does [Participant Name] exhibit the following ...

SELECT the rating that best reflects the employee's performance in the areas listed.


What does Feedback mean?
It means that ...
  • You accept the views of others.
  • You consider other's opinion and suggestions.
  • You look to others for input.
  • You seek feedback to enhance performance.
  • You actively seek feedback from others.

To what extent does this person exhibit Feedback?
Select from one of the ratings below.

Project Management

What does Project Management mean?
It means that ...
  • You develop action items, workplans, timelines, and criteria for projects.
  • You develop performance measures for various aspects of the project.
  • You define project outcomes based on customer requirements.
  • You respond quickly and appropriately to unforeseen problems.
  • You anticipate potential problems and institute controls and contingency plans to address them.

To what extent does this person exhibit Project Management?
Select from one of the ratings below.

Decision Making

What does Decision Making mean?
It means that ...
  • You ask for additional information when making critical decisions.
  • You exercise good judgment by making sound and informed decisions.
  • You break complex issues into manageable parts and organize them in a systematic way before making decisions
  • You seek input from key people who should be involved in, or will be affected by, decisions
  • You do not lose sight of the big picture when making decisions

To what extent does this person exhibit Decision Making?
Select from one of the ratings below.


What does Safety mean?
It means that ...
  • You work to implement corrective safety measures.
  • You are aware of osha safety guidelines.
  • You are committed to safety in the workplace.
  • You commit adequate resources toward safety measures.
  • You participate in safety training when offered.

To what extent does this person exhibit Safety?
Select from one of the ratings below.

Co-worker Development

What does Co-worker Development mean?
It means that ...
  • You set and clearly communicate expectations, performance goals, and measurements to others
  • You give others development opportunities through project assignments and increased job responsibilities
  • You provide ongoing feedback to co-workers on your development progress
  • You work to identify root causes of performance problems
  • You take immediate action on poor performance

To what extent does this person exhibit Co-worker Development?
Select from one of the ratings below.

Areas for Development

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