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.

Sample Result Document:
Sample Results
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. Encourages others on the team to suggest process improvements.
  1. Initiates important conversation topics at meetings.
  1. Begins immediate action on projects.
  1. Creates solutions to problems as soon as an incident occurs.
  1. Able to initiate work on projects independently without direct supervision.

Change Management

Agree Unsure Disagree N/A
  1. Develops a strategy for implementing changes.
  1. Able to get department employees to accept new changes.
  1. Adopts changes to set and example for others to follow.
  1. Is an inspiration for others to accept the recent changes.
  1. Is a leading force driving changes.


Agree Unsure Disagree N/A
  1. Works effectively during periods of change.
  1. Open to the perspectives/viewpoints of others.
  1. Can handle changes without complaining.
  1. Identifies new opportunities to achieve goals
  1. Encourages others to adopt new procedures.

Bias for Action

Agree Unsure Disagree N/A
  1. Encourages risk taking and experimentation to improve performance
  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. Conveys a sense of urgency about addressing problems and opportunities
  1. Projects a "can-do" attitude when interfacing with peers, subordinates and customers(especially during difficult and challenging times).

Self Management

Agree Unsure Disagree N/A
  1. Uses patience and self-control in working with customers and associates.
  1. Deals with conflict by controlling own emotions by listening, being flexible, and sincere in responding.
  1. Sets an example for associates during stressful periods by maintaining a positive, can-do attitude.
  1. Is aware of personal impact on others and adjusts behavior to create a positive leadership presence.
  1. Consciously controls own negative emotions in order to keep team morale up.

Continual Learning

Agree Unsure Disagree N/A
  1. Is open to new ideas and concepts.
  1. Views setbacks as opportunities to learn from.
  1. Grasps new ideas, concepts, technical, or business knowledge.
  1. Sets relevant learning objectives and goals.
  1. Takes charge of their training and skills enhancement.


Agree Unsure Disagree N/A
  1. Looks to others for input.
  1. Asks others for their ideas and opinions.
  1. Considers other's opinion and suggestions.
  1. Open to the suggestions of others.
  1. Shares past experiences with others as learning opportunities.


Agree Unsure Disagree N/A
  1. Willingly shares information and expertise; sought out as resource by others
  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. Is naturally sought out by people outside his/her particular area for advice and opinion on a broad range of matters - not necessarily solely legal advice.
  1. Knows how to produce high quality products/work.


Agree Unsure Disagree N/A
  1. Able to organize work.
  1. Establishes goals and objectives.
  1. Assures [Company] principles are understood, employed & pursued.
  1. Consistently provides me with timely feedback for improving my performance.
  1. Ability to establish realistic goals.


Agree Unsure Disagree N/A
  1. Completes assigned work tasks.
  1. Sets a good example.
  1. Responsible for setting the vision of the department.
  1. Acts as a resource without removing individual responsibility.
  1. Holds herself / himself accountable to goals / objectives


Agree Unsure Disagree N/A
  1. Maintains infrastructure to support partnerships and networks.
  1. Forges mutually beneficial relationships between individuals with diverse backgrounds.
  1. Partners with peers to obtain influence within the Company.
  1. Develops a sense of trust in subordinates so they can freely interact and share information with others.
  1. Collaborates with others to accomplish goals and objectives.

Strategic Focus

Agree Unsure Disagree N/A
  1. Understands & contributes to development of strategic goals.
  1. Communicates goals and objectives to employees.
  1. Able to decline a poor strategy by proposing alternate strategies.
  1. Understands their role within the organization.
  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 [Participant Name Here].

  2. Strengths

  3. Areas for Development

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