Persuasion and Influence - 360 Degree Feedback Survey Sample #8

Questionnaires Measuring Persuasion and Influence:
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)

You have been selected to provide feedback for the manager listed above. Your feedback is an important part of 's leadership development process. This tool 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 assessment form, please think about your experiences working with this individual during the last six to twelve months. Your responses will be merged with other people's feedback and presented to to guide them in their on-going development. Comments will be shared anonymously, as written, with the manager.

Sample Result Document:
Sample Results
Method of use: As part of the review process, managers will receive feedback from peers and staff. It is recognized that not all participants will be able to assess an individual's performance in all areas. The feedback received will be utilized as input to the manager's performance and on-going development plan.

You may sign out at any time by pressing the Save button at the end of the form and then closing your browser. You may return later to pick up where you left off. When you are done, press the Complete button.

When clicking your selection below, try to best fit the manager's actual behaviors to the scale provided.

If you are not sure, or unable to assess, select "Not Applicable" (N/A) option.

Please complete your response by .

Persuasion and Influence

Agree Unsure Disagree N/A
  1. Communicates effectively with others.
  1. Attempts to persuade others rather than simply control them.
  1. Able to express own goals and needs.
  1. Ensures stakeholders are involved in the decision making process.
  1. Has excellent influencing/negotiating skills.

Problem Solving

Agree Unsure Disagree N/A
  1. Makes judgments based upon relevant information.
  1. Solves problems using logic and insight.
  1. Understands the root causes of problems.
  1. Generates alternative solutions to problems and challenges.
  1. Ability to develop innovative solutions to problems.


Agree Unsure Disagree N/A
  1. Contributes to a positive and fun work environment.
  1. Builds open and trusting relationships.
  1. Visibly supports and encourages diversity in style and background.
  1. Contributes to a positive work environment.
  1. Works to eliminate unnecessary work or barriers that get in others' way.

Cultural Awareness

Agree Unsure Disagree N/A
  1. Is curious and willing to ask questions about the cultural differences in the workplace.
  1. Actively listens to other employees' stories about their culture.
  1. Acknowledges their own biases in cultural interactions.
  1. Avoids referring to stereotypes about others from different cultures.
  1. Willing to work with employees who have different cultural backgrounds.


Agree Unsure Disagree N/A
  1. Initiates draft reports for consideration.
  1. Immediately informs the supervisor of any critical incidents.
  1. Seeks and utilizes opportunities for continuous learning and self-development.
  1. Does things without being told.
  1. Creates solutions to problems as soon as an incident occurs.

Results Oriented

Agree Unsure Disagree N/A
  1. Directs team in prioritizing daily work activities
  1. Helps others when free-time is available.
  1. Inspires and motivates co-workers to be productive and energetic at work
  1. Does not become distracted by non-issues or interruptions.
  1. Encourages a high-energy, fun work environment and coaches others on how to do the same


Agree Unsure Disagree N/A
  1. Makes sure employees understand why they were given certain assignments.
  1. Is clear about the roles and duties of team members.
  1. Uses appropriate grammar and tense in communications.
  1. Writes clear job descriptions for positions in the organization.
  1. Attends to the important details of a job or task.

Managing Risk

Agree Unsure Disagree N/A
  1. Is aware of the financial implications of certain risks.
  1. Seeks to increase safety in the workplace.
  1. Performs a risk analysis as needed.
  1. Is concerned about process safety management.
  1. Committed to implementing rules and procedures to minimize risk.

Co-worker Development

Agree Unsure Disagree N/A
  1. Provides ongoing feedback to co-workers on their development progress
  1. Takes immediate action on poor performance
  1. Gives others development opportunities through project assignments and increased job responsibilities
  1. Sets and clearly communicates expectations, performance goals, and measurements to others
  1. Works to identify root causes of performance problems


Agree Unsure Disagree N/A
  1. Able to influence others to accept certain positions.
  1. Identifies verbal and nonverbal cues to help interpret actions and messages.
  1. Maintains good interpersonal relationships with representatives from the other party.
  1. Changes communication styles to meet the listener's needs.
  1. Actively listens to conversations to be able to recall important details later.

  1. Overall, please rate the effectiveness of [Participant Name Here].

  2. Strengths

  3. Areas for Development

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