Initiative - 360 Degree Feedback Survey Sample #3





Questionnaires Measuring Initiative:
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)
Self-Assessment Instructions

Leadership at [Company] are participating in a 360-Degree Feedback assessment. As part of this process, you need to complete a self-assessment questionnaire form. Other employees, including your manager(s), peers, and direct reports will also evaluate you. In this manner, you will be provided with a comprehensive, multi-perspective (i.e., 360-degree) view of your performance as a manager. The objective is to provide you with feedback so as to allow you to improve your performance, resulting in improved team performance, and organizational effectiveness.

If you are not able to respond to an item, leave it blank and go on to the next item.

Competencies Included:
Initiative, Communication Skills, Action, Self Management, Management, Project Management, Delegation, Partnering/Networking, Business Acumen, Strategic Insight, Global Perspective
Sample Result Document:
Sample Results
We encourage everyone to complete the survey. Please be honest, constructive and thoughtful in your input. The survey is designed to help us understand more about your thoughts and needs to make this a great company.

Please ensure that your submission is made between . The survey will only be available during these dates.






Initiative

Does Not
Exhibit this
Competency
Seldom
Exhibits this
Competency
Sometimes
Exhibits this
Competency
Usually
Exhibits this
Competency
Always
Exhibits this
Competency
  1. You go above and beyond the stated goals.
  1. You prepare for unexpected contingencies.
  1. I encourage others on the team to suggest process improvements.
  1. You are a self-starter. You do not wait to be told to do something.
  1. I take advantage of opportunities when they become available.
Please feel free to provide any comments to help explain your answers?

Communication Skills

Does Not
Exhibit this
Competency
Seldom
Exhibits this
Competency
Sometimes
Exhibits this
Competency
Usually
Exhibits this
Competency
Always
Exhibits this
Competency
  1. I am approachable, dependable, and ready to assist when needed.
  1. You listen actively & speaks clearly and directly.
  1. I discuss ideas and concepts with peers.
  1. You communicate Corporate initiatives in a relevant and actionable manner to employees within your organization.
  1. You prepare and deliver presentations.
Please feel free to provide any comments to help explain your answers?

Action

Does Not
Exhibit this
Competency
Seldom
Exhibits this
Competency
Sometimes
Exhibits this
Competency
Usually
Exhibits this
Competency
Always
Exhibits this
Competency
  1. I overcome obstacles that may impede progress on a task.
  1. I act immediately instead of waiting for someone else to solve the issue.
  1. I take action in critical situations.
  1. I convert plans into actions.
  1. You take advantage of opportunities to move the organization forward.
Please feel free to provide any comments to help explain your answers?

Self Management

Does Not
Exhibit this
Competency
Seldom
Exhibits this
Competency
Sometimes
Exhibits this
Competency
Usually
Exhibits this
Competency
Always
Exhibits this
Competency
  1. You analyze interpersonal problems instead of reacting to them.
  1. You deal with conflict by controlling own emotions by listening, being flexible, and sincere in responding.
  1. You step away from a situation to process appropriate response.
  1. You set an example for associates during stressful periods by maintaining a positive, can-do attitude.
  1. You consciously control own negative emotions in order to keep team morale up.
Please feel free to provide any comments to help explain your answers?

Management

Does Not
Exhibit this
Competency
Seldom
Exhibits this
Competency
Sometimes
Exhibits this
Competency
Usually
Exhibits this
Competency
Always
Exhibits this
Competency
  1. You take responsibility for things that go wrong
  1. You keep staff informed about what is happening in the company
  1. You delegate tasks effectively
  1. You set an example for others to follow
  1. You are ready to offer help
Please feel free to provide any comments to help explain your answers?

Project Management

Does Not
Exhibit this
Competency
Seldom
Exhibits this
Competency
Sometimes
Exhibits this
Competency
Usually
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Competency
Always
Exhibits this
Competency
  1. I identify the project time and budget constraints.
  1. You have the requisite industry knowledge to manage projects in this field.
  1. You accurately determine the number of staff needed for the project.
  1. You identify potential risks to completing the project on time.
  1. You work with customers and clients to assess their needs and define project parameters.
Please feel free to provide any comments to help explain your answers?

Delegation

Does Not
Exhibit this
Competency
Seldom
Exhibits this
Competency
Sometimes
Exhibits this
Competency
Usually
Exhibits this
Competency
Always
Exhibits this
Competency
  1. You define goals and objectives for subordinates.
  1. You encourage and empower subordinates to use initiative in achieving goals and objectives.
  1. You tell subordinates what to do, not how to do it.
  1. You delegate tasks, responsibilities, and accountability as appropriate to the level of employee.
  1. You define the roles, responsibilities, required actions, and deadlines for team members.
Please feel free to provide any comments to help explain your answers?

Partnering/Networking

Does Not
Exhibit this
Competency
Seldom
Exhibits this
Competency
Sometimes
Exhibits this
Competency
Usually
Exhibits this
Competency
Always
Exhibits this
Competency
  1. You form collaborative relationships with others.
  1. You seek to avoid conflicts by clarifying problems early on and working quickly to resolve those issues.
  1. I develop effective peer to peer working relationships.
  1. You exchange innovative ideas with others in the network.
  1. I facilitate inter-departmental collaboration and information sharing.
Please feel free to provide any comments to help explain your answers?

Business Acumen

Does Not
Exhibit this
Competency
Seldom
Exhibits this
Competency
Sometimes
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Competency
Usually
Exhibits this
Competency
Always
Exhibits this
Competency
  1. I seek to better understand other areas of the company, including their operations, personnel, and output.
  1. You understand and apply business and financial principles.
  1. You create strategic plans that conform with regulations and industry guidelines.
  1. I develop business plans that are forward looking.
  1. You are able to correctly assess current/estimated valuations.
Please feel free to provide any comments to help explain your answers?

Strategic Insight

Does Not
Exhibit this
Competency
Seldom
Exhibits this
Competency
Sometimes
Exhibits this
Competency
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Competency
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Competency
  1. You analyze records and reports to obtain insight into potential issues and trends.
  1. You have conversations with customers and clients to get a better insight into their personal needs.
  1. I create a vision for the organization based on insights gathered from other companies in the industry.
  1. I observe employees at work to get better insight into the issues they are dealing with.
  1. You identify root causes of problems.
Please feel free to provide any comments to help explain your answers?

Global Perspective

Does Not
Exhibit this
Competency
Seldom
Exhibits this
Competency
Sometimes
Exhibits this
Competency
Usually
Exhibits this
Competency
Always
Exhibits this
Competency
  1. You can effectively deliver presentations to international clients.
  1. You analyze global issues/problems that are having a large impact on the Company.
  1. You build working relationships with others across cultures.
  1. You cooperate with others on a global scale.
  1. You demonstrate working knowledge of global transactions.
Please feel free to provide any comments to help explain your answers?

  1. Overall, please rate the effectiveness of [Participant Name].






  2. Strengths


  3. Areas for Development


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