Integrity - 360 Degree Feedback Survey Sample #10

360 Feedback Survey

Questionnaires Measuring Integrity:
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.


  • Maintains strong relationships with others.
  • Accepts responsibility for mistakes.
  • Fosters a high standard of ethics and integrity.
  • Demonstrates honesty and truthfulness at all times.
  • Fosters an environment built upon trust.
If [Participant Name] were to make improvements in Integrity, what are your suggestions for how he/she can improve this?


  • Flexible and open to new ideas and encourages others to value change.
  • Able to quickly learn new ways of performing their job.
  • Willing to change ideas or perceptions based on new information or contrary evidence which is presented.
  • Recognizes and implements changes to enhance efficiency and effectiveness.
  • Works effectively in dynamic and changing work environments.
If [Participant Name] were to make improvements in Adaptability, what are your suggestions for how he/she can improve this?


  • Demonstrates a well-organized and timely approach to achieve desired results
  • Completes work to given time frame and to budget
  • Set high standards in their performance
  • Schedules time for self and others to optimize high priority and long term actions. Monitors progress towards business goals.
  • Systematically works to improve the organization
If [Participant Name] were to make improvements in Achievement, what are your suggestions for how he/she can improve this?

Customer Focus

  • Considers customers point of view when making decisions.
  • Consistently models positive customer service attitudes.
  • Develops good rapport and trust with the customer.
  • Ensures all customer commitments and requirements are met or exceeded.
  • ...friendliness and courtesy
If [Participant Name] were to make improvements in Customer Focus, what are your suggestions for how he/she can improve this?


  • Seeks an understanding of diverse functions within the Company.
  • Forges mutually beneficial relationships between individuals with diverse backgrounds.
  • Promotes the understanding of how the department affects the organization overall.
  • Maintains infrastructure to support partnerships and networks.
  • Supports and encourages relationships that are created by diverse team members.
If [Participant Name] were to make improvements in Partnering/Networking, what are your suggestions for how he/she can improve this?
Overall, please rate the effectiveness of [Participant Name Here].


Areas for Development

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