Innovation - 360 Degree Feedback Survey Sample #11

360 Feedback Survey

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)

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.

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.

To what extent does [Participant Name] exhibit the following ...

SELECT the rating that best reflects the employee's performance in the areas listed.


What does Innovation mean?
It means that ...
  • You challenge current procedures to develop other alternatives.
  • You create a safe environment for idea-sharing.
  • You implement best practices within the department.
  • You build upon the ideas and solutions of others.
  • You suggest new ideas at meetings.

To what extent does this person exhibit Innovation?
Select from one of the ratings below.

Change Management

What does Change Management mean?
It means that ...
  • You adopt changes to set and example for others to follow.
  • You are effective in implementing new organizational vision and values.
  • You work cooperatively with others to implement changes.
  • You assist others in understanding changes to the organization.
  • You address organizational and departmental resistance to changes.

To what extent does this person exhibit Change Management?
Select from one of the ratings below.

Self Management

What does Self Management mean?
It means that ...
  • You analyze own reactions on the spot to ensure that communication does not appear to be driven by anger.
  • You do not allow own emotions to interfere with the performance of others.
  • You deal with conflict by controlling own emotions by listening, being flexible, and sincere in responding.
  • You use patience and self-control in working with customers and associates.
  • You are aware of personal impact on others and adjusts behavior to create a positive leadership presence.

To what extent does this person exhibit Self Management?
Select from one of the ratings below.


What does Punctuality mean?
It means that ...
  • You start the workday when scheduled.
  • You respond to requests for information in a timely manner.
  • You invoice clients on a timely basis.
  • You start meetings on time.
  • You conduct appointments at scheduled start time.

To what extent does this person exhibit Punctuality?
Select from one of the ratings below.

Time Management

What does Time Management mean?
It means that ...
  • You focus on tasks that have high priority.
  • You make time for developing plans and schedules.
  • You complete high-priority work within required timelines.
  • You set clearly defined goals.
  • You do not become flustered by deadlines and timelines.

To what extent does this person exhibit Time Management?
Select from one of the ratings below.

Areas for Development

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