Initiative - 360 Degree Feedback Survey Sample #9

360 Feedback Survey

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)

Thank you for providing feedback for the recipient above. As you respond, please draw on your first-hand experience with this individual in the past 12 months. Rate each item using the scale shown. If you don't feel you have enough first-hand information to rate a certain item, please choose the Not Applicable option. Comments can be very helpful; at a minimum where you give a particularly high or low rating, please share your reasons in the comment section for that competency. Your responses will be compiled with feedback from others and presented to the recipient to help guide their ongoing development.

Sample Result Document:
Sample Results
Partially completed forms can be saved by using the Save/Still Working button at the bottom of the page. You may return at a later time to complete/edit the form. Your saved responses will be shown each time you re-visit the feedback form. When you are certain that you have completed your responses and will be not making any changes, click the Complete button.


Definite Strength Meets Standards Needs Development 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. Goes above and beyond the stated goals.
  1. Takes action without being asked.
  1. Immediately works to complete goals well before their deadline.

Change Management

Definite Strength Meets Standards Needs Development N/A
  1. Effective in implementing new organizational vision and values.
  1. Supports new initiatives for organizational changes to improve effectiveness.
  1. Addresses organizational and departmental resistance to changes.
  1. Effective in dealing with ambiguous and challenging situations.
  1. Works cooperatively with others to implement changes.

Commitment To Result

Definite Strength Meets Standards Needs Development N/A
  1. Creates a sense of urgency among the store team members to complete activities, which drive sales.
  1. Coordinates all department activities into a cohesive team effort.
  1. Takes immediate action toward goals.
  1. Conveys strong sense of own pride in Company to associates by creating a shared vision around sales and customer service.
  1. Able to focus on a task even when working alone.

Self Management

Definite Strength Meets Standards Needs Development N/A
  1. Uses patience and self-control in working with customers and associates.
  1. Analyzes own reactions on the spot to ensure that communication does not appear to be driven by anger.
  1. Is aware of personal impact on others and adjusts behavior to create a positive leadership presence.
  1. Deals with conflict by controlling own emotions by listening, being flexible, and sincere in responding.
  1. Does not allow own emotions to interfere with the performance of others.

Continual Learning

Definite Strength Meets Standards Needs Development N/A
  1. Grasps new ideas, concepts, technical, or business knowledge.
  1. Takes the initiative to learn new skills.
  1. Pursues learning that will enhance job performance.
  1. Improves on their skill sets.
  1. Pursues professional development opportunities when they arise.

Establishing Focus/Direction

Definite Strength Meets Standards Needs Development N/A
  1. Stays focused even when under pressure and stress.
  1. Excellent at managing time.
  1. Maintains self-control when personally criticized.
  1. Makes sure that employees understand how their work relates to organizational goals.
  1. Makes sure that employees understand and identify with the team's mission.

Project Management

Definite Strength Meets Standards Needs Development N/A
  1. Regularly reviews project performance and goals.
  1. Organizes work and sets priorities as needed.
  1. Able to adjust project schedule as needed to accommodate unforeseen issues.
  1. Develops action items, workplans, timelines, and criteria for projects.
  1. Maintains costs and expenses within budget limits.


Definite Strength Meets Standards Needs Development N/A
  1. Allows employees to decide how they wish to complete the tasks.
  1. Entrusts subordinates with important tasks.
  1. Delegates authority and responsibility to subordinates and holds them accountable for their actions.
  1. Allows subordinates to use their own methods and procedures.
  1. Assigns tasks to create learning opportunities for the employees.


Definite Strength Meets Standards Needs Development N/A
  1. Encourages others to work safely.
  1. Is not afraid to question a potential safety issue observed in the workplace.
  1. Mitigates hazards and safety issues that arise.
  1. Encourages others to attend safety training.
  1. Keeps accurate safety records.

Empowering Others

Definite Strength Meets Standards Needs Development N/A
  1. Lets employees make their own decisions.
  1. Expresses confidence in the abilities of others.
  1. Sets clear goals for others to accomplish.
  1. Set clear goals for assignments.
  1. Supports the decisions of others.


Definite Strength Meets Standards Needs Development N/A
  1. Changes communication styles to meet the listener's needs.
  1. Conducts necessary preparations before engaging in negotiations.
  1. Able to say "no" when it is essential to maintaining quality and high standards.
  1. Influences others through rational argument and persuasion.
  1. Stays calm and focuses on the core issues to be discussed.


Definite Strength Meets Standards Needs Development N/A
  1. Develops action plans to align his/her work with the goals of the organization
  1. Leads employees in new directions.
  1. Demonstrates consistency between words and actions
  1. Expresses the Company vision in a way that is easily understood and adopted by employees.
  1. Creates a positive vision of the future for the Company.

  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.