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Others- 360 Degree Feedback Survey Sample #1





360-Degree Feedback Survey

Surveys Measuring Others:
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)
Instructions:

[Company] is conducting a 360-Degree Feedback Assessment developed by HR-Survey for selected managers.

You have been selected to provide feedback on the employee listed above. Your 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 working with this employee over the last twelve months. 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 be aggregated with the responses received from others and discussed with the employee to foster growth and on-going 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.

Competencies Included:
Others, Attitude, Leadership, Delegation, Goals, Juggling Multiple Responsibilities, Managing Risk, Trustworthy, Coaching, Recognition, Planning
Sample Result Document:
Sample Results
Your feedback is valuable in helping the individual to understand how they are perceived and experienced by others and the impact their behavior has on people in the organization with whom they interact. Feedback received also acknowledges strengths and identifies areas for development.

Use the form below to provide your feedback. Each field and comment box requires a response before you can SUBMIT your final feedback.

Please ensure that your submission is made between . The survey will only be available during these dates.

Thank you for your participation in the survey. We look forward to seeing the analysis of your responses and we are hoping for 100% participation.

Management Team
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Others

Needs
Improvement
Meets
Minimum
Standards
Is
Proficient
Role
Model
  1. Works effectively with people from other departments.
  1. ...treats others with respect and dignity.
  1. Able to see issues from others' perspectives.
  1. Consistently demonstrates ability and willingness to trust others.
  1. Includes others in the decision making processes.
If [Participant Name] were to make improvements in Others, what are your suggestions for how he/she can improve this?

Attitude

Needs
Improvement
Meets
Minimum
Standards
Is
Proficient
Role
Model
  1. Shows empathy in their interactions with others.
  1. Speaks positively about the organizational direction, helping staff see the bigger picture.
  1. Holds themselves accountable for their performance and results.
  1. Invites participation by asking open-ended questions and valuing all voices.
  1. Uses affirming language that emphasizes strengths, possibilities, and momentum.
If [Participant Name] were to make improvements in Attitude, what are your suggestions for how he/she can improve this?

Leadership

Needs
Improvement
Meets
Minimum
Standards
Is
Proficient
Role
Model
  1. Provides clear directions for others to follow.
  1. Encourages creativity and expects innovative contributions from everyone.
  1. Takes ownership and accountability for results
  1. Celebrates initiative and recognizes employees who take ownership beyond their core responsibilities.
  1. Provides early warning to subordinate leaders of tasks they will be responsible for.
If [Participant Name] were to make improvements in Leadership, what are your suggestions for how he/she can improve this?

Delegation

Needs
Improvement
Meets
Minimum
Standards
Is
Proficient
Role
Model
  1. Does not intervene in delegated tasks unless performance, risk, or alignment issues arise.
  1. Equips employees with the support and resources needed to execute delegated tasks that advance team priorities.
  1. Uses structured formats (e.g., task matrices, SOPs, checklists) to communicate responsibilities.
  1. Fosters an environment in which the employee believes in their capabilities to meet expectations, takes the initiative, and delivers high-quality results.
  1. Proactively identifies tasks that align with an employee's development and career progression.
If [Participant Name] were to make improvements in Delegation, what are your suggestions for how he/she can improve this?

Goals

Needs
Improvement
Meets
Minimum
Standards
Is
Proficient
Role
Model
  1. Sets goals for themselves professionally.
  1. Regularly tracks progress on meeting performance goals.
  1. Adjusts goals according to the progress of employees.
  1. Able to stay focused and avoid distractions that would disrupt the attainment of a goal.
  1. Sets strategic goals for expanding into new geographical markets.
If [Participant Name] were to make improvements in Goals, what are your suggestions for how he/she can improve this?

Juggling Multiple Responsibilities

Needs
Improvement
Meets
Minimum
Standards
Is
Proficient
Role
Model
  1. Spends the most time and effort on critical tasks first.
  1. Avoids bottlenecks in progress by assigning multiple individuals to critical tasks.
  1. Prioritizes tasks for efficiency.
  1. Builds in extra time in the schedule for unplanned events/occurrences.
  1. Is aware of the deadlines for specific tasks/assignments.
If [Participant Name] were to make improvements in Juggling Multiple Responsibilities, what are your suggestions for how he/she can improve this?

Managing Risk

Needs
Improvement
Meets
Minimum
Standards
Is
Proficient
Role
Model
  1. Creates a level of resilience in the organization.
  1. Determines a proportional response in relation to the level of risk.
  1. Determines the impact of specific risks on infrastructure.
  1. Determines the risk tolerance of the company.
  1. Adopts a risk-based approach to establishing systems of internal controls.
If [Participant Name] were to make improvements in Managing Risk, what are your suggestions for how he/she can improve this?

Trustworthy

Needs
Improvement
Meets
Minimum
Standards
Is
Proficient
Role
Model
  1. Is a person you can trust.
  1. Seeks to mitigate grievances by clarifying intentions and finding suitable remedies.
  1. Is trustworthy; is someone I can trust.
  1. Consistently keeps commitments.
  1. Demonstrates congruence between statements and actions.
If [Participant Name] were to make improvements in Trustworthy, what are your suggestions for how he/she can improve this?

Coaching

Needs
Improvement
Meets
Minimum
Standards
Is
Proficient
Role
Model
  1. Offers constructive feedback to improve performance.
  1. Provides guidance and feedback to help accomplish a task or solve a problem.
  1. Asks questions that lead to discovery, insight or action.
  1. Sets aside time for formal coaching discussions.
  1. Asks clarifying questions to get a better understanding of assumptions, positions, and goals.
If [Participant Name] were to make improvements in Coaching, what are your suggestions for how he/she can improve this?

Recognition

Needs
Improvement
Meets
Minimum
Standards
Is
Proficient
Role
Model
  1. Offers recognition in a timely manner.
  1. Offers recognition that reflects the employee's personal values, aspirations, and contributions in a way that feels authentic.
  1. Recognizes when the team excels on a project or reaches a major milestone.
  1. Is fair when making any monetary awards.
  1. Knows which employees complete the most work.
If [Participant Name] were to make improvements in Recognition, what are your suggestions for how he/she can improve this?

Planning

Needs
Improvement
Meets
Minimum
Standards
Is
Proficient
Role
Model
  1. Analyzes market trends to plan the best course of action.
  1. Adjusts and rearranges the schedule to maximize efficiency.
  1. Anticipates potential challenges, develops plan to overcome them and then carries out the plan.
  1. Conducts regular assessments of the project status to ensure adherence to the set schedule.
  1. Accurately estimates the amount of materials/supplies needed for the project.
If [Participant Name] were to make improvements in Planning, what are your suggestions for how he/she can improve this?

  1. What are [Participant Name Here]'s greatest strengths demonstrated this year?


  2. What are [Participant Name Here]'s areas for development?


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