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)

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 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 action without being asked.
  1. Goes above and beyond the stated goals.
  1. Immediately works to complete goals well before their deadline.
  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.

Change Management

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


Agree Unsure Disagree N/A
  1. Open to the perspectives/viewpoints of others.
  1. Willing to try new ideas.
  1. Implements changes as a result of having listened to employees
  1. Effective in incorporating new ideas.
  1. Identifies new opportunities to achieve goals

Bias for Action

Agree Unsure Disagree N/A
  1. Completes work on time
  1. Completes a large volume of work.
  1. Identifies ways to simplify work processes and reduce cycle times
  1. Coach others to foster an environment which can adapt quickly and willingly to rapid change.
  1. Seeks and utilizes opportunities for continuous learning and self-development.

Self Management

Agree Unsure Disagree N/A
  1. Steps away from a situation to process appropriate response.
  1. Does not allow own emotions to interfere with the performance of others.
  1. Consciously controls own negative emotions in order to keep team morale up.
  1. Uses patience and self-control in working with customers and associates.
  1. Sets an example for associates during stressful periods by maintaining a positive, can-do attitude.

Continual Learning

Agree Unsure Disagree N/A
  1. Grasps new ideas, concepts, technical, or business knowledge.
  1. Builds on their strengths while addressing their weaknesses.
  1. Sets relevant learning objectives and goals.
  1. Shares best practices with others and learns from others.
  1. Pursues self-improvement through continual learning.


Agree Unsure Disagree N/A
  1. Asks others for their ideas and opinions.
  1. Shares past experiences with others as learning opportunities.
  1. Seeks feedback to enhance performance.
  1. Accepts the views of others.
  1. Considers other's opinion and suggestions.


Agree Unsure Disagree N/A
  1. Willingly shares information and expertise; sought out as resource by others
  1. Is knowledgeable of procedures or systems necessary for the job.
  1. Seeks information from others as needed.
  1. Keeps current with technical advances within his/her professional discipline; embraces and applies new techniques and practices
  1. Knows how to produce high quality products/work.


Agree Unsure Disagree N/A
  1. Sets long-term and short-term goals.
  1. Encourages me to take on greater responsibility.
  1. Communicates goals and objectives to employees.
  1. Able to organize work.
  1. Consistently provides me with timely feedback for improving my performance.


Agree Unsure Disagree N/A
  1. Is a person you can trust.
  1. ...takes personal responsibility for results.
  1. Holds herself / himself accountable to goals / objectives
  1. Acts as a resource without removing individual responsibility.
  1. Works in a way that makes others want to work with her/him.


Agree Unsure Disagree N/A
  1. Collaborates with others to accomplish goals and objectives.
  1. Develops a sense of trust in subordinates so they can freely interact and share information with others.
  1. Maintains infrastructure to support partnerships and networks.
  1. Supports and encourages relationships that are created by diverse team members.
  1. Creates value within the Company by building networks.

Strategic Focus

Agree Unsure Disagree N/A
  1. Understands their role within the organization.
  1. Creates plans to develop and promote organizational and area strengths, as well as to address weaknesses.
  1. Understands & contributes to development of strategic goals.
  1. Communicates goals and objectives to employees.
  1. Monitors performance of each market within the Area, utilizing reports to ensure sales growth, cost management, and profitability targets are met.

  1. Overall, please rate the effectiveness of .

  2. Strengths

  3. Areas for Development

  4. Please give any final comments or suggestions for 's assessment.