Initiative - 360 Degree Feedback Survey Sample #8

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)

You have been selected to provide feedback for the manager listed above. Your feedback is an important part of 's leadership development process. This tool is intended to gather broad feedback in the core competencies and role responsibilities that are important for the on-going success of our organization.

In responding to the assessment form, please think about your experiences working with this individual during the last six to twelve months. Your responses will be merged with other people's feedback and presented to guide them in their on-going development. Comments will be shared anonymously, as written, with the manager.

Method of use: As part of the review process, managers will receive feedback from peers and staff. It is recognized that not all participants will be able to assess an individual's performance in all areas. The feedback received will be utilized as input to the manager's performance and on-going development plan.

You may sign out at any time by pressing the Save button at the end of the form and then closing your browser. You may return later to pick up where you left off. When you are done, press the Complete button.

When clicking your selection below, try to best fit the manager's actual behaviors to the scale provided.

If you are not sure, or unable to assess, select "Not Applicable" (N/A) option.

Please complete your response by .


Agree Unsure Disagree N/A
  1. Takes the initiative to change the direction or course of events.
  1. Coach others to foster an environment which can adapt quickly and willingly to rapid change.
  1. Prepares for unexpected contingencies.
  1. Takes decisive action to address problems, following up with relevant team members and coaching them on how to improve.
  1. Goes above and beyond the stated goals.

Change Management

Agree Unsure Disagree N/A
  1. Assists others in understanding changes to the organization.
  1. Supports the Company's efforts to implement changes.
  1. Adopts changes to set and example for others to follow.
  1. Effective in implementing new organizational vision and values.
  1. Works cooperatively with others to implement changes.


Agree Unsure Disagree N/A
  1. Implements changes as a result of having listened to employees
  1. Is open to alternative ways to accomplish goals
  1. Acts decisively in frequently changing and uncertain environment.
  1. Willing to try new ideas.
  1. Adapts to new organizational structures, policies, or procedures.

Bias for Action

Agree Unsure Disagree N/A
  1. Displays high energy and enthusiasm on consistent basis.
  1. Seeks and utilizes opportunities for continuous learning and self-development.
  1. Coach others to foster an environment which can adapt quickly and willingly to rapid change.
  1. Projects a "can-do" attitude when interfacing with peers, subordinates and customers(especially during difficult and challenging times).
  1. Completes a large volume of work.

Self Management

Agree Unsure Disagree N/A
  1. Steps away from a situation to process appropriate response.
  1. Analyzes own reactions on the spot to ensure that communication does not appear to be driven by anger.
  1. Consciously controls own negative emotions in order to keep team morale up.
  1. Does not allow own emotions to interfere with the performance of others.
  1. Analyzes interpersonal problems instead of reacting to them.

Continual Learning

Agree Unsure Disagree N/A
  1. Shares best practices with others and learns from others.
  1. Grasps new ideas, concepts, technical, or business knowledge.
  1. Is open to new ideas and concepts.
  1. Improves on their skill sets.
  1. Seeks opportunities to grow in skills and knowledge.


Agree Unsure Disagree N/A
  1. Seeks feedback to enhance performance.
  1. Is easy to approach with ideas and opinions.
  1. Asks others for their ideas and opinions.
  1. Accepts the views of others.
  1. Actively seeks feedback from others.


Agree Unsure Disagree N/A
  1. Willingly shares his/her technical expertise; sought out as resource by others
  1. Is knowledgeable of procedures or systems necessary for the job.
  1. Willingly shares information and expertise; sought out as resource by others
  1. Uses expertise to identify issues and think through creative solutions to get a problem solved or objective accomplished.
  1. Demonstrates mastery of the technical competencies required in his/her work.


Agree Unsure Disagree N/A
  1. Encourages me to take on greater responsibility.
  1. Able to organize work.
  1. Sets long-term and short-term goals.
  1. Assures [Company] principles are understood, employed & pursued.
  1. Consistently provides me with timely feedback for improving my performance.


Agree Unsure Disagree N/A
  1. Holds herself / himself accountable to goals / objectives
  1. Sets high personal standards of performance.
  1. Completes assigned work tasks.
  1. Sets a good example
  1. Is a person you can trust.


Agree Unsure Disagree N/A
  1. Builds alliances between departments and teams.
  1. Maintains infrastructure to support partnerships and networks.
  1. Supports and encourages relationships that are created by diverse team members.
  1. Forges mutually beneficial relationships between individuals with diverse backgrounds.
  1. Creates value within the Company by building networks.

Strategic Focus

Agree Unsure Disagree N/A
  1. Understands & contributes to development of strategic goals.
  1. Looks for opportunities to enhance contributions to the bottom line.
  1. Sustains or achieves a competitive advantage for the organization by analyzing the best practices and lessons learned from other organizations.
  1. Creates plans to develop and promote organizational and area strengths, as well as to address weaknesses.
  1. Focuses attention on treating the causes of problems rather than simply addressing the symptoms.

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

  2. Strengths

  3. Areas for Development

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