Innovation - 360 Degree Feedback Survey Sample #8

Questionnaires Measuring Innovation:
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 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. Creates improved methods or solutions for meeting goals and objectives.
  1. Takes risks to advance important ideas.
  1. Challenges current procedures to develop other alternatives.
  1. Implements best practices within the department.
  1. Offers constructive improvements to existing systems.


Agree Unsure Disagree N/A
  1. Achieves goals.
  1. Conducts timely follow-up; keeps others informed on a need to know basis.
  1. Makes sure that I have a clear idea of our group's goals.
  1. Sets high expectations and goals; encourages others to support the organization.
  1. Achieves established goals.

Results Oriented

Agree Unsure Disagree N/A
  1. Does not become distracted by non-issues or interruptions.
  1. Demonstrates the personal confidence to "stay the course," even when faced with difficulty
  1. Directs team in prioritizing daily work activities
  1. Helps others when free-time is available.
  1. Encourages a high-energy, fun work environment and coaches others on how to do the same


Agree Unsure Disagree N/A
  1. Demonstrates the analytical skills to do their job.
  1. Can be counted on to add value wherever they are involved.
  1. Takes a lot of pride in their work.
  1. Demonstrates the functional or technical skills necessary to do their job.
  1. Is planful and organized.

Interpersonal Skills

Agree Unsure Disagree N/A
  1. Anticipates the concerns of other employees.
  1. Is a role model for others
  1. Demonstrates willingness to work with others.
  1. Strives for win/win solutions
  1. Is trusted by peers and co-workers; others are willing to confide in him/her

Customer Focus

Agree Unsure Disagree N/A
  1. Considers customers point of view when making decisions.
  1. Asks questions and listens carefully to determine customer needs and to ensure that the customer's needs are met.
  1. Develops good rapport and trust with the customer.
  1. Consistently models positive customer service attitudes.
  1. Develops strong customer relationships.


Agree Unsure Disagree N/A
  1. Forges mutually beneficial relationships between individuals with diverse backgrounds.
  1. Supports and encourages relationships that are created by diverse team members.
  1. Seeks an understanding of diverse functions within the Company.
  1. Maintains infrastructure to support partnerships and networks.
  1. Develops a sense of trust in subordinates so they can freely interact and share information with others.

Business Acumen

Agree Unsure Disagree N/A
  1. Exhibits behavior that is consistent with the vision, mission, and core values of the organization
  1. Understands complex issues and problems.
  1. Considers impact of actions on other areas of the organization.
  1. Effectively develops and uses resources (people, time, money, supplies, equipment, and space) to improve organizational performance
  1. Asks the 'right' questions to size up or evaluate situations.

Strategic Insight

Agree Unsure Disagree N/A
  1. Formulates policies and strategies for addressing the Company's important challenges.
  1. Understands the Company's strengths and weaknesses and uses this information to create optimal solutions to problems.
  1. Communicates vision for the department and company.
  1. Maintains knowledge of current trends in the industry.
  1. Implements long-term solutions to problems.


Agree Unsure Disagree N/A
  1. Able to look ahead (beyond the present) when addressing the work/needs of the department.
  1. Works in an organized manner
  1. Anticipates obstacles and ways to overcome them.
  1. Anticipates potential challenges, develops plan to overcome them and then carries out the plan.
  1. Delegates role to team members to accomplish goals.

Continual Improvement

Agree Unsure Disagree N/A
  1. Looks for ways to expand current job responsibilities.
  1. Encourages an employee culture of continuous improvement to seek out better ways of doing things.
  1. Promotes training and development opportunities to enhance job performance.
  1. Open to the suggestions from others.
  1. Looks for ways to improve work processes and procedures.


Agree Unsure Disagree N/A
  1. Conducts appointments at scheduled start time.
  1. Starts meetings on time.
  1. Arrives to meetings on time.
  1. Invoices clients on a timely basis.
  1. Avoids making personal phone calls during working hours.

Persuasion and Influence

Agree Unsure Disagree N/A
  1. Able to express own goals and needs.
  1. Ensures stakeholders are involved in the decision making process.
  1. Attempts to persuade others rather than simply control them.
  1. Understanding what others need.
  1. Seeks to obtain consensus or compromise.

  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.