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.


  • Sets high expectations and goals; encourages others to support the organization.
  • Achieves established goals.
  • Understands & contributes to development of strategic goals.
  • Establishes and documents goals and objectives.
  • Goal Setting
If [Participant Name] were to make improvements in Goals, what are your suggestions for how he/she can improve this?

Self Management

  • Analyzes own reactions on the spot to ensure that communication does not appear to be driven by anger.
  • Consciously controls own negative emotions in order to keep team morale up.
  • Uses patience and self-control in working with customers and associates.
  • Deals with conflict by controlling own emotions by listening, being flexible, and sincere in responding.
  • Is aware of personal impact on others and adjusts behavior to create a positive leadership presence.
If [Participant Name] were to make improvements in Self Management, what are your suggestions for how he/she can improve this?

Administrative Skill

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


  • Builds and maintains the trust of others.
  • Demonstrates a sense of responsibility and commitment to public trust.
  • Consistently keeps commitments.
  • Takes ownership, delivers on commitments
  • Is a person you can trust.
If [Participant Name] were to make improvements in Trustworthy, what are your suggestions for how he/she can improve this?

Strategic Insight

  • Understands the Company's strengths and weaknesses and uses this information to create optimal solutions to problems.
  • Formulates policies and strategies for addressing the Company's important challenges.
  • Identifies potential problems before they become critical incidents.
  • Formulates strategies and action plans to ensure successful completion of goals and objectives.
  • Maintains knowledge of current trends in the industry.
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.