Goals - 360 Degree Feedback Survey Sample #10

360 Feedback Survey

Questionnaires Measuring Goals:
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.


  • Conducts timely follow-up; keeps others informed on a need to know basis.
  • Understands & contributes to development of strategic goals.
  • Makes sure that I have a clear idea of our group's goals.
  • Sets high expectations and goals; encourages others to support the organization.
  • Achieves established goals.
If [Participant Name] were to make improvements in Goals, what are your suggestions for how he/she can improve this?

Self Management

  • Analyzes interpersonal problems instead of reacting to them.
  • Sets an example for associates during stressful periods by maintaining a positive, can-do attitude.
  • Steps away from a situation to process appropriate response.
  • Uses patience and self-control in working with customers and associates.
  • Analyzes own reactions on the spot to ensure that communication does not appear to be driven by anger.
If [Participant Name] were to make improvements in Self Management, what are your suggestions for how he/she can improve this?

Administrative Skill

  • Implements and uses performance measures.
  • Enthusiastic about taking on challenging projects.
  • Able to develop, justify and present a budget.
  • High attention to detail.
  • Accurately implements contract provisions.
If [Participant Name] were to make improvements in Administrative Skill, what are your suggestions for how he/she can improve this?


  • Consistently keeps commitments.
  • Demonstrates a sense of responsibility and commitment to public trust.
  • Works in a way that makes others want to work with her/him.
  • Seeks to mitigate grievances by clarifying intentions and finding suitable remedies.
  • Takes care to maintain confidential information.
If [Participant Name] were to make improvements in Trustworthy, what are your suggestions for how he/she can improve this?

Strategic Insight

  • Communicates vision for the department and company.
  • Formulates policies and strategies for addressing the Company's important challenges.
  • Maintains knowledge of current trends in the industry.
  • Anticipates business cycles and trends and makes adjustments in a timely manner.
  • Analyzes records and reports to obtain insight into potential issues and trends.
If [Participant Name] were to make improvements in Strategic Insight, 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.