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)
Survey 13 (4-point scale; numbers)
Survey 14 (4-point scale; N/A)
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.

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. I inspire others to perform above expectations.
  1. I look for opportunities to move projects forward.
  1. You guide strategic initiatives to advance the department/organization.
  1. You anticipate what needs to be done and makes necessary preparations.
  1. I take the initiative to solve pressing issues.
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. You listen actively & speaks clearly and directly.
  1. You listen to others' points of view with an open mind
  1. I recap action steps from meetings to ensure clarity and execution.
  1. I produce written content that is both succinct and orderly.
  1. You present issues, ideas, and strategy concisely and clearly.
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 move forward on important projects.
  1. You decide to act rather than remain passive.
  1. You approve purchase requests in a timely manner.
  1. You make effective decisions
  1. I am proactive in developing solutions to problems.
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 do not allow own emotions to interfere with the performance of others.
  1. You are aware of personal impact on others and adjusts behavior to create a positive leadership presence.
  1. You deal with conflict by controlling own emotions by listening, being flexible, and sincere in responding.
  1. You set an example for associates during stressful periods by maintaining a positive, can-do attitude.
  1. You use patience and self-control in working with customers and associates.
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 make others feel enthusiastic about your work
  1. You keep staff informed about what is happening in the company
  1. You are ready to offer help
  1. You set an example for others to follow
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
Exhibits this
Competency
Always
Exhibits this
Competency
  1. I understand what software tools are available to be used to manage the project.
  1. You implement risk mitigation strategies to help move the project to successful completion.
  1. You accurately determine the number of staff needed for the project.
  1. I identify critical requirements for each phase of the project.
  1. You communicate the results of the project, at the conclusion, to all stakeholders.
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 set clear and reasonable expectations for others and follow through on their progress.
  1. You define the roles, responsibilities, required actions, and deadlines for team members.
  1. You allow subordinates to use their own methods and procedures.
  1. You clearly define duties and tasks to be completed.
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. I actively prevent conflicts by identifying issues early and resolving them promptly.
  1. You create the conditions for partnerships to grow and develop.
  1. You develop key business relationships with clients/customers.
  1. I build trust with colleagues and coworkers.
  1. I use networks of personal contacts to gain introductions to others who may have valuable information.
Please feel free to provide any comments to help explain your answers?

Business Acumen

Does Not
Exhibit this
Competency
Seldom
Exhibits this
Competency
Sometimes
Exhibits this
Competency
Usually
Exhibits this
Competency
Always
Exhibits this
Competency
  1. I collect valuable customer insights to ensure our services meet their needs.
  1. You exhibit behavior that is consistent with the vision, mission, and core values of the organization
  1. I assist others in better understanding the company's operations, goals, and strategic challenges.
  1. I establish key performance indicators (KPIs) to measure progress and success.
  1. You anticipate customer's business needs.
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
Usually
Exhibits this
Competency
Always
Exhibits this
Competency
  1. You create a mission statement describing the purpose for the organization.
  1. You formulate policies and strategies for addressing the Company's important challenges.
  1. You adjust strategic plans based on insights gathered from different points of view.
  1. You strategically align projects to the goals of the company.
  1. You have conversations with customers and clients to get a better insight into their personal needs.
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 cooperate with others on a global scale.
  1. You consider customers point of view when making decisions.
  1. You are comfortable using teleconferencing equipment to facilitate meetings with others abroad.
  1. You facilitate open communication with individuals from other countries.
  1. You analyze global issues/problems that are having a large impact on the Company.
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.