Objectives - 360 Degree Feedback Survey Sample #8

Questionnaires Measuring Objectives:
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)
Self-Assessment Instructions

You have been selected to complete a self-assessment questionnaire as part of a 360-degree feedback assessment. 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.

Respond to the assessment form based on your work experiences during the previous 12 months. Your responses will be merged with other people's feedback and presented to you in your on-going development. Comments from others will be shared anonymously, as written.

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. You communicate goals and objectives to employees.
  1. You work toward achieving established goals and objectives.
  1. You effectively organize resources and plans
  1. You are able to establish realistic goals.
  1. You are able to organize work.


Agree Unsure Disagree N/A
  1. You take calculated risks to achieve higher levels of performance.
  1. You rapidly complete tasks and assignments.
  1. You are driven to complete assignments on time.
  1. You strive to exceed standards of performance.
  1. You demonstrate a well-organized and timely approach to achieve desired results

Establishing Focus/Direction

Agree Unsure Disagree N/A
  1. You set appropriate goals for employees.
  1. You function well under stress, deadlines, and/or significant workloads.
  1. You help guide employees with prioritizing tasks.
  1. You align the department's goals with the goals of the organization.
  1. You make sure that employees understand and identify with the team's mission.


Agree Unsure Disagree N/A
  1. You challenge current procedures to develop other alternatives.
  1. You develop new products and services.
  1. You analyze current procedures and identify opportunities for improvement.
  1. You take risks to advance important ideas.
  1. You find creative ways to get things done with limited resources.

Interpersonal Skills

Agree Unsure Disagree N/A
  1. You successfully resolve conflicts and grievances to a win-win solution.
  1. You anticipate the concerns of other employees.
  1. You apply appropriate communication techniques to the situation.
  1. You demonstrate compassion and understanding of others.
  1. You come across as credible, knowledgeable and sincere


Agree Unsure Disagree N/A
  1. You act as a resource without removing individual responsibility.
  1. You set a good example
  1. Your behavior is ethical and honest.
  1. You hold yourself accountable to goals / objectives
  1. You work in a way that makes others want to work with you.


Agree Unsure Disagree N/A
  1. You provide clear, motivating, and constructive feedback.
  1. You conduct regular performance appraisals and feedback.
  1. You meet regularly with employees to coach them on areas that will enhance your performance
  1. You help employees to understand responsibilities, authority, and expectations.
  1. You coach employees in how to strengthen knowledge and skills to improve work performance.


Agree Unsure Disagree N/A
  1. You are able to see issues from others' perspectives.
  1. You consistently demonstrate ability and willingness to trust others.
  1. You form working relationships with employees from other departments.
  1. You support the efforts of other employees in implementing solutions to problems.
  1. You constructively receive criticism and suggestions from others.

Cultural Awareness

Agree Unsure Disagree N/A
  1. You value the opinions of diverse groups and individual.
  1. You foster a diverse workforce free from discrimination and harassment.
  1. You recognize and value individual and cultural differences.
  1. You maintain an inclusive work environment that maximizes the talents of others in achieving goals.
  1. You show respect in daily interactions

Global Perspective

Agree Unsure Disagree N/A
  1. You respect individual differences.
  1. You form strong client relationships with international partners.
  1. You apply knowledge of overseas markets.
  1. You understand global systems such as the global economy.
  1. You understand how cultures differ and how these differences impact work behavior.

  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.