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Interpersonal Skills - 360 Degree Feedback Survey Sample #2





Questionnaires Measuring Interpersonal Skills:
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)
Survey 13 (4-point scale; numbers; floating anchors)
Survey 14 (4-point scale; N/A)
Self-Assessment Instructions

You have been asked to complete a self-assessment questionnaire form (shown below). You will also receive feedback from others such as your peers, direct reports and manager. Feedback is an important part of our company's leadership development process and this survey 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 questions below, think about your experiences as an employee over the last twelve months and the goals you were asked to achieve. The effectiveness of this development tool is dependent on your honest, forthright and constructive responses so please bear this in mind as you answer each question. Your responses will become part of the assessment process to foster your growth and on-going development.

Competencies Included:
Interpersonal Skills, Self Management, Feedback, Management, Persuasion and Influence, Problem Solving, Objectives, Client Focus, Co-worker Development, Company
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.

Please ensure that your submission is made between . The survey will only be available during these dates.
Edit this Survey
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Interpersonal Skills

Clear
Strength
Capable
and
Effective
Could
Benefit from
Development
Needs
Significant
Improvement
  1. You communicate well at all levels of the organization.
  1. I demonstrate positive behaviors for others to follow.
  1. You anticipate the concerns of other employees.
  1. I value the input from coworkers.
  1. I offer praise to colleagues who have successfully completed major projects.
What are your suggestions for how you can make improvements
in Interpersonal Skills?

Self Management

Clear
Strength
Capable
and
Effective
Could
Benefit from
Development
Needs
Significant
Improvement
  1. You analyze interpersonal problems instead of reacting to them.
  1. You deal with conflict by controlling own emotions by listening, being flexible, and sincere in responding.
  1. You are aware of personal impact on others and adjusts behavior to create a positive leadership presence.
  1. You step away from a situation to process appropriate response.
  1. You use patience and self-control in working with customers and associates.
What are your suggestions for how you can make improvements
in Self Management?

Feedback

Clear
Strength
Capable
and
Effective
Could
Benefit from
Development
Needs
Significant
Improvement
  1. You proactively seek input from diverse sources to ensure all perspectives are acknowledge and different viewpoints are taken into account.
  1. You take the feedback to heart and implement changes where necessary.
  1. I ensure the protection and confidentiality of those providing feedback.
  1. You implement actionable strategies to address any issues identify through feedback.
  1. I base feedback on observable/observed behaviors or specific instances.
What are your suggestions for how you can make improvements
in Feedback?

Management

Clear
Strength
Capable
and
Effective
Could
Benefit from
Development
Needs
Significant
Improvement
  1. I am a strong advocate for the interests of the company/employee.
  1. You establish expected performance standards.
  1. You manage deadlines to ensure critical work is completed without delay.
  1. You consider the long-term impact of decisions and take responsibility for potential risks.
  1. I set a visible example of accountability and focus, prompting peers to adopt similar standards.
What are your suggestions for how you can make improvements
in Management?

Persuasion and Influence

Clear
Strength
Capable
and
Effective
Could
Benefit from
Development
Needs
Significant
Improvement
  1. You align proposals with factual trends or performance benchmarks to underscore relevance and urgency.
  1. I reinforce key messages through repetition, storytelling, and strategic emphasis, making them memorable and actionable.
  1. You listen actively to oppose viewpoints and respond with thoughtful counterarguments rather than defensiveness.
  1. You attempt to persuade others rather than simply control them.
  1. You know when, where, and how to act based on the context.
What are your suggestions for how you can make improvements
in Persuasion and Influence?

Problem Solving

Clear
Strength
Capable
and
Effective
Could
Benefit from
Development
Needs
Significant
Improvement
  1. I analyze the information available, considers alternatives, make the best choice available.
  1. I create a table or chart to compare the solutions side-by-side across all evaluation criteria.
  1. You are flexible and willing to adjust your approach when new information or changes in the environment arise.
  1. You effectively use a variety of problem-solving/analytical approaches to address challenges within the area.
  1. You weigh the pros and cons of proposed solutions.
What are your suggestions for how you can make improvements
in Problem Solving?

Objectives

Clear
Strength
Capable
and
Effective
Could
Benefit from
Development
Needs
Significant
Improvement
  1. You establish goals and objectives.
  1. You organize and schedules events, activities, and resources.
  1. You set long-term and short-term goals.
  1. You are able to organize work.
  1. You work toward achieving established goals and objectives.
What are your suggestions for how you can make improvements
in Objectives?

Client Focus

Clear
Strength
Capable
and
Effective
Could
Benefit from
Development
Needs
Significant
Improvement
  1. I accept responsibility for ensuring client satisfaction.
  1. You create customized solutions for the client.
  1. You consistently demonstrate a client focus.
  1. You treat clients with courtesy and respect.
  1. I promptly respond to clients.
What are your suggestions for how you can make improvements
in Client Focus?

Co-worker Development

Clear
Strength
Capable
and
Effective
Could
Benefit from
Development
Needs
Significant
Improvement
  1. You adapt coaching and mentoring approach to meet the style or needs of individuals
  1. You provide ongoing feedback to co-workers on your development progress
  1. You set and clearly communicate expectations, performance goals, and measurements to others
  1. You take immediate action on poor performance
  1. You work to identify root causes of performance problems
What are your suggestions for how you can make improvements
in Co-worker Development?

Company

Clear
Strength
Capable
and
Effective
Could
Benefit from
Development
Needs
Significant
Improvement
  1. You maintain the high ethical standards of the company.
  1. I provide a workspace that is comfortable and conducive to long hours of work.
  1. I help employees see their work as a reflection of the company's purpose and legacy.
  1. I define clear roles and responsibilities to reduce friction and enhance coordination
  1. I outline expected behaviors and help determine ethical standards across all levels of the organization.
What are your suggestions for how you can make improvements
in Company?


  1. Strengths


  2. Areas for Development


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