Problem Solving - 360 Degree Feedback Survey Sample #8

Questionnaires Measuring Problem Solving:
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)
Self-Assessment Instructions

You have been selected to complete a self-assessment questionnaire as part of a 360-degree feedback assessment. 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.

Respond to the assessment form based on your work experiences during the previous 12 months. Your responses will be merged with other people's feedback and presented to you in your on-going development. Comments from others will be shared anonymously, as written.

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 .

Problem Solving

Agree Unsure Disagree N/A
  1. You actively seek the root cause of a problem.
  1. You are effective in solving problems.
  1. You generate alternative solutions to problems and challenges.
  1. You can develop innovative solutions to problems.
  1. You identify and assess all potential responses to a problem.


Agree Unsure Disagree N/A
  1. You challenge current procedures to develop other alternatives.
  1. You take risks to advance important ideas.
  1. You implement best practices within the department.
  1. You build upon the ideas and solutions of others.
  1. You foster a creative and innovative work environment.


Agree Unsure Disagree N/A
  1. You can handle changes without complaining.
  1. You adapt to new organizational structures, policies, or procedures.
  1. You are able to adapt to new situations.
  1. You identify new opportunities to achieve goals
  1. You are effective in incorporating new ideas.

Passion To Learn

Agree Unsure Disagree N/A
  1. You recognize own areas for development and consciously seek assignments that will provide practice in areas of developmental need.
  1. You will participate in training classes even if offered outside of normal working hours.
  1. You are open to feedback from others.
  1. You demonstrate through personal behavior the commitment to high standards of performance.
  1. You create an environment that supports personal development and exploration.

Cultural Awareness

Agree Unsure Disagree N/A
  1. You treat others with dignity and respect.
  1. You encourage a work environment where individual differences are valued.
  1. I recognize individual and cultural differences.
  1. You understand what customs and etiquette are important for individuals from other cultures.
  1. You accept individual differences.

Establishing Focus/Direction

Agree Unsure Disagree N/A
  1. You make sure that employees understand and identify with the team's mission.
  1. You are excellent at managing time.
  1. You align the department's goals with the goals of the organization.
  1. You function well under stress, deadlines, and/or significant workloads.
  1. You set appropriate goals for employees.

Administrative Skill

Agree Unsure Disagree N/A
  1. You have strong organizational skills to keep the workspace and department in order
  1. You implement and use performance measures.
  1. You complete reports on-time.
  1. You accurately implement contract provisions.
  1. You take responsibility for decisions.

Commitment To Result

Agree Unsure Disagree N/A
  1. You maintain persistence and dedication to achieving results.
  1. You coordinate all department activities into a cohesive team effort.
  1. You are willing to do whatever it takes-not afraid to have to put in extra effort.
  1. You are able to focus on a task even when working alone.
  1. You create a sense of urgency among the store team members to complete activities, which drive sales.


Agree Unsure Disagree N/A
  1. You communicate goals and objectives to employees.
  1. You are able to establish realistic goals.
  1. You effectively organize resources and plans
  1. You are able to organize work.
  1. You consistently provide me with timely feedback for improving my performance.


Agree Unsure Disagree N/A
  1. You are a person others can trust.
  1. Your behavior is ethical and honest.
  1. You set a good example.
  1. You act as a resource without removing individual responsibility.
  1. You are responsible for setting the vision of the department.

Co-worker Development

Agree Unsure Disagree N/A
  1. You give others development opportunities through project assignments and increased job responsibilities
  1. You take immediate action on poor performance
  1. You set and clearly communicate expectations, performance goals, and measurements to others
  1. You work to identify root causes of performance problems
  1. You adapt coaching and mentoring approach to meet the style or needs of individuals

Strategic Insight

Agree Unsure Disagree N/A
  1. You understand the Company's strengths and weaknesses and uses this information to create optimal solutions to problems.
  1. You create strategies that significantly benefit the Company.
  1. You implement long-term solutions to problems.
  1. You analyze unique issues or problems impacting the Company.
  1. You identify potential problems before they become critical incidents.

  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.