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Performance - 360 Degree Feedback Survey Sample #2





Questionnaires Measuring Performance:
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:
Performance, Administrative Skill, Technology Use/Management, Creativity, Self Management, Persuasion and Influence, Clarity, Developing Others, Business Acumen, Strategic Insight
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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Performance

Clear
Strength
Capable
and
Effective
Could
Benefit from
Development
Needs
Significant
Improvement
  1. You are able to organize your work.
  1. You use relevant facts to measure and track progress toward achievement of individual and team goals.
  1. You meet regularly to discuss job performance.
  1. You support employees who volunteer for challenging assignments or new roles.
  1. You demonstrate consistent effort regardless of external pressures.
What are your suggestions for how you can make improvements
in Performance?

Administrative Skill

Clear
Strength
Capable
and
Effective
Could
Benefit from
Development
Needs
Significant
Improvement
  1. I have effective oral and written communication skills.
  1. You dress appropriately for the workplace and represent the organization with a polished, professional appearance.
  1. I communicate information and ideas in speaking so others will understand.
  1. You develop action item and to-do list from issues discussed in meetings.
  1. I structure presentation content logically, using clear sections and transition that guide the audience through key points.
What are your suggestions for how you can make improvements
in Administrative Skill?

Technology Use/Management

Clear
Strength
Capable
and
Effective
Could
Benefit from
Development
Needs
Significant
Improvement
  1. You reallocate resources away from redundant or underperforming technologies, redirecting support toward solutions that improve productivity and outcomes.
  1. You redefine technology use metrics and governance.
  1. You identify sources of resistance and proactively address concerns to maintain momentum.
  1. I track the percentage of code generated with AI assistance by the team.
  1. I collaborate with teams to map new workflows.
What are your suggestions for how you can make improvements
in Technology Use/Management?

Creativity

Clear
Strength
Capable
and
Effective
Could
Benefit from
Development
Needs
Significant
Improvement
  1. You use knowledge and problem solving to find creative solutions.
  1. You encourage playful thinking and ideation, using prompts, scenarios, or creative exercises to unlock fresh perspectives.
  1. I consider problems from multiple angles to uncover new approaches.
  1. I envision possibilities beyond current constraints or norms.
  1. You commit to continuous learning; understanding that creative outcomes are derived from learn experiences.
What are your suggestions for how you can make improvements
in Creativity?

Self Management

Clear
Strength
Capable
and
Effective
Could
Benefit from
Development
Needs
Significant
Improvement
What are your suggestions for how you can make improvements
in Self Management?

Persuasion and Influence

Clear
Strength
Capable
and
Effective
Could
Benefit from
Development
Needs
Significant
Improvement
  1. You use credibility, consistency, and demonstrate expertise to shape how others interpret situations and evaluate options.
  1. I create a sense of personal connection by engaging others in meaningful dialogue which deepens trust and influence.
  1. I am able to influence others to meet certain goals.
  1. I reframe disagreements as a path to better understanding, clarity and trust.
  1. I use structured negotiation techniques (such as option-generation, reframing, or interest-mapping) to move stalled discussions forward and build durable agreement.
What are your suggestions for how you can make improvements
in Persuasion and Influence?

Clarity

Clear
Strength
Capable
and
Effective
Could
Benefit from
Development
Needs
Significant
Improvement
  1. You clearly define work objectives for employees.
  1. You use appropriate grammar and tense in communications.
  1. You maintain clarity in goals and objectives.
  1. You are clear about the roles and duties of team members.
  1. You write clear job descriptions for positions in the organization.
What are your suggestions for how you can make improvements
in Clarity?

Developing Others

Clear
Strength
Capable
and
Effective
Could
Benefit from
Development
Needs
Significant
Improvement
  1. You support the successes of other employees.
  1. You encourage employees through recognition of positive changes in behavior.
  1. You recognize and celebrates accomplishments of others.
  1. You assess employees' developmental needs.
  1. You try to ensure employees are ready to move to the next level.
What are your suggestions for how you can make improvements
in Developing Others?

Business Acumen

Clear
Strength
Capable
and
Effective
Could
Benefit from
Development
Needs
Significant
Improvement
  1. You are able to align resources to meet the business needs of the company.
  1. You reward risky ideas that may yield significant benefits to the business.
  1. You effectively troubleshoot customer business issues.
  1. I recognize trends in underlying data.
  1. I understand how strategic decisions impact constituents within the Company.
What are your suggestions for how you can make improvements
in Business Acumen?

Strategic Insight

Clear
Strength
Capable
and
Effective
Could
Benefit from
Development
Needs
Significant
Improvement
  1. You identify potential problems before they become critical incidents.
  1. You identify opportunities for innovation by watching how employees adapt tools, processes, or customer interactions.
  1. I recognize unspoken concerns or morale issues through body language, tone, and team interactions.
  1. You formulate policies and strategies for addressing the Company's important challenges.
  1. You implement long-term solutions to problems.
What are your suggestions for how you can make improvements
in Strategic Insight?


  1. Strengths


  2. Areas for Development


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