Others- 360 Degree Feedback Survey Sample #11

360 Feedback Survey

Assessments 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)

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 Others mean?
It means that ...
  • You work across boundaries within the organization.
  • You are able to see issues from others' perspectives.
  • You support the efforts of other employees in implementing solutions to problems.
  • You respect the opinions of other employees.
  • You constructively receive criticism and suggestions from others.

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

Commitment To Result

What does Commitment To Result mean?
It means that ...
  • You are willing to do whatever it takes-not afraid to have to put in extra effort.
  • You coordinate all department activities into a cohesive team effort.
  • You maintain persistence and dedication to achieving results.
  • You take immediate action toward goals.
  • You are able to focus on a task even when working alone.

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

Self Management

What does Self Management mean?
It means that ...
  • You analyze own reactions on the spot to ensure that communication does not appear to be driven by anger.
  • You use patience and self-control in working with customers and associates.
  • You deal with conflict by controlling own emotions by listening, being flexible, and sincere in responding.
  • You are aware of personal impact on others and adjusts behavior to create a positive leadership presence.
  • You analyze interpersonal problems instead of reacting to them.

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

Fiscal Management

What does Fiscal Management mean?
It means that ...
  • You develop budgets and plans for various programs and initiatives.
  • You are effective in using company's resources.
  • You monitor spending.
  • You effectively manage appropriations, reporting, purchases, expenditures, payrolls, and staff.
  • You ensure others follow the correct rules and regulations on fiscal matters.

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

Persuasion and Influence

What does Persuasion and Influence mean?
It means that ...
  • You have excellent influencing/negotiating skills.
  • You communicate effectively with others.
  • You understand what others need.
  • You ensure stakeholders are involved in the decision making process.
  • You attempt to persuade others rather than simply control them.

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

Areas for Development

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