Objectives - 360 Degree Feedback Survey Sample #11

360 Feedback Survey

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)

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 Objectives mean?
It means that ...
  • You work toward achieving established goals and objectives.
  • You organize and schedules events, activities, and resources.
  • You are able to establish realistic goals.
  • You consistently provide me with timely feedback for improving my performance.
  • You assure [Company] principles are understood, employed & pursued.

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

Strategic Insight

What does Strategic Insight mean?
It means that ...
  • You formulate policies and strategies for addressing the Company's important challenges.
  • You anticipate business cycles and trends and makes adjustments in a timely manner.
  • You implement long-term solutions to problems.
  • You communicate vision for the department and company.
  • You maintain knowledge of current trends in the industry.

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

Supervisory Skills

What does Supervisory Skills mean?
It means that ...
  • You delegate effectively.
  • You provide constructive, ongoing feedback.
  • You treat all staff equitably.
  • You encourage employees to achieve your full potential.
  • You resolve personnel problems quickly and effectively.

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

Interpersonal Skills

What does Interpersonal Skills mean?
It means that ...
  • You use tact, compassion, and sensitivity in interactions with others.
  • You demonstrate willingness to work with others.
  • You use knowledge and charisma rather than position, power, or coercion to influence others
  • You express appreciation of other's work.
  • You strive for win/win solutions

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

Customer Focus

What does Customer Focus mean?
It means that ...
  • You ask questions and listen carefully to determine customer needs and to ensure that the customer's needs are met.
  • You develop good rapport and trust with the customer.
  • You develop strong customer relationships.
  • You ensure all customer commitments and requirements are met or exceeded.
  • You consistently model positive customer service attitudes.

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

Areas for Development

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