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 listen and respond to issues and problems
  • You produce quality
  • You shown significant improvement in job performance.
  • You are able to organize work.
  • You work well in this position.

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 motivate others to achieve or exceed goals
  • You display high energy and enthusiasm on consistent basis.
  • You seek and utilize opportunities for continuous learning and self-development.
  • You identify ways to simplify work processes and reduce cycle times
  • You complete a large volume of work.

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 are clear about goals that need to be achieved.
  • You communicate ideas and facts clearly and effectively in writing.
  • You clearly define work objectives for employees.
  • You use appropriate grammar and tense in communications.
  • You adjust communication methods to the needs of the audience.

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 of the department's annual budget.
  • You are effective in using company's resources.
  • You effectively manage appropriations, reporting, purchases, expenditures, payrolls, and staff.
  • You monitor expenses and verify the need for items purchased.
  • You develop budgets and plans for various programs and initiatives.

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 manage your own emotions.
  • You help to make decisions and solve problems using knowledge about how others will react in certain situations.
  • You are able to understand others' points of view.
  • You help employees to resolve conflicts, communicate clearly, and work together to solve problems.
  • You are attentive to emotional cues and interprets others' feelings correctly.

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.