Performance - 360 Degree Feedback Survey Sample #11

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.

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 Performance mean?
It means that ...
  • You work effectively in the department.
  • You are effective in performing your job.
  • You have great overall performance
  • You effectively organize resources and plans
  • You set a high standard for job performance.

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

Bias for Action

What does Bias for Action mean?
It means that ...
  • You display high energy and enthusiasm on consistent basis.
  • You project a "can-do" attitude when interfacing with peers, subordinates and customers(especially during difficult and challenging times).
  • You motivate others to achieve or exceed goals
  • You identify ways to simplify work processes and reduce cycle times
  • You seek and utilize opportunities for continuous learning and self-development.

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


What does Clarity mean?
It means that ...
  • You maintain clarity in goals and objectives.
  • You check details thoroughly.
  • You avoid stating unclear or conflicting goals.
  • You make sure goals and objectives are clearly and thoroughly explained and understood.
  • You clarify problems and your causes to help employees correct them.

To what extent does this person exhibit Clarity?
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 monitor spending.
  • You effectively manage appropriations, reporting, purchases, expenditures, payrolls, and staff.
  • You develop of the department's annual budget.
  • 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.

Emotional Intelligence

What does Emotional Intelligence mean?
It means that ...
  • You are able to understand others' points of view.
  • You are able to express yourself clearly.
  • You are attentive to emotional cues and interprets others' feelings correctly.
  • You are able to control your own emotions.
  • You are able to manage your own emotions.

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

Areas for Development

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