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.

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. Ensures stakeholders are involved in the decision making process.
  1. Develops a good rapport with others.
  1. Seeks to obtain consensus or compromise.
  1. Communicates effectively with others.
  1. Has excellent influencing/negotiating skills.

Problem Solving

Agree Unsure Disagree N/A
  1. Solves problems using logic and insight.
  1. Identifies and assesses all potential responses to a problem.
  1. Works cooperatively with others to solve problems.
  1. Is a good problem solver and decision maker
  1. Ability to develop innovative solutions to problems.


Agree Unsure Disagree N/A
  1. Shows by their actions that they trust in the positive intentions of others.
  1. Treats all people fairly and with respect.
  1. Builds open and trusting relationships.
  1. Is gracious and professional in their interactions with others.
  1. Works to eliminate unnecessary work or barriers that get in others' way.

Cultural Awareness

Agree Unsure Disagree N/A
  1. Recognizes and values individual and cultural differences.
  1. Values the opinions of diverse groups and individual.
  1. Shows respect in daily interactions
  1. Maintains an inclusive work environment that maximizes the talents of others in achieving goals.
  1. Fosters a diverse workforce free from discrimination and harassment.


Agree Unsure Disagree N/A
  1. Takes action without being asked.
  1. Goes above and beyond the stated goals.
  1. Takes the initiative to change the direction or course of events.
  1. Coach others to foster an environment which can adapt quickly and willingly to rapid change.
  1. Seeks and utilizes opportunities for continuous learning and self-development.

Results Oriented

Agree Unsure Disagree N/A
  1. Helps others when free-time is available.
  1. Explains the "whys" behind organizational objectives
  1. Demonstrates the personal confidence to "stay the course," even when faced with difficulty
  1. Encourages a high-energy, fun work environment and coaches others on how to do the same
  1. Works toward achievement of goals even when confronted with obstacles.


Agree Unsure Disagree N/A
  1. Avoids creating ambiguity or mixed messages.
  1. Checks details thoroughly.
  1. Clarifies problems and their causes to help employees correct them.
  1. Communicates ideas and facts clearly and effectively in writing.
  1. Maintains clarity in goals and objectives.

Managing Risk

Agree Unsure Disagree N/A
  1. Rewards innovative experiments to try new ideas.
  1. Able to adapt quickly to changing situations.
  1. Responds appropriately to unexplained or unanticipated events.
  1. Maintains open communication with other departments.
  1. Avoids maintaining the status quo (or standard operating procedures) when addressing new and influential situations.

Co-worker Development

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


Agree Unsure Disagree N/A
  1. Able to clearly express thoughts and concerns.
  1. Changes communication styles to meet the listener's needs.
  1. Stays calm and focuses on the core issues to be discussed.
  1. Is able to decline bad ideas to avoid making poor decisions.
  1. Researches the needs of the other party to identify strengths and weaknesses of positions.

  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.