Performance - 360 Degree Feedback Survey Sample #10

360 Feedback Survey

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)

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.


  • Sets a high standard for job performance.
  • Works well in this position.
  • Shown significant improvement in job performance.
  • Effectively organizes resources and plans
  • ...Overall Performance
If [Participant Name] were to make improvements in Performance, what are your suggestions for how he/she can improve this?


  • Prepares for unexpected contingencies.
  • Coach others to foster an environment which can adapt quickly and willingly to rapid change.
  • Seeks and utilizes opportunities for continuous learning and self-development.
  • Takes the initiative to change the direction or course of events.
  • Immediately works to complete goals well before their deadline.
If [Participant Name] were to make improvements in Initiative, what are your suggestions for how he/she can improve this?

Business Acumen

  • Applies the knowledge of work processes to influence the achievement of business goals
  • Asks the 'right' questions to size up or evaluate situations.
  • Effectively develops and uses resources (people, time, money, supplies, equipment, and space) to improve organizational performance
  • Understands complex issues and problems.
  • Considers impact of actions on other areas of the organization.
If [Participant Name] were to make improvements in Business Acumen, what are your suggestions for how he/she can improve this?

Customer Focus

  • Develops good rapport and trust with the customer.
  • Develops strong customer relationships.
  • Asks questions and listens carefully to determine customer needs and to ensure that the customer's needs are met.
  • Ensures all customer commitments and requirements are met or exceeded.
  • Maintains positive customer relationships.
If [Participant Name] were to make improvements in Customer Focus, what are your suggestions for how he/she can improve this?

Emotional Intelligence

  • Is able to express themselves clearly.
  • Accurately perceives the emotional reactions of others.
  • Is able to manage their own emotions.
  • Is able to control their own emotions.
  • Helps to make decisions and solve problems using knowledge about how others will react in certain situations.
If [Participant Name] were to make improvements in Emotional Intelligence, what are your suggestions for how he/she can improve this?
Overall, please rate the effectiveness of [Participant Name Here].


Areas for Development

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