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 generate alternative solutions to problems and challenges.
  1. You work cooperatively with others to solve problems.
  1. You are able to solve problems at root cause rather than at symptom level.
  1. You can develop innovative solutions to problems.
  1. You identify fresh approaches and shows a willingness to question traditional assumptions.


Agree Unsure Disagree N/A
  1. You foster a creative and innovative work environment.
  1. You implement best practices within the department.
  1. You create a safe environment for idea-sharing.
  1. You find creative ways to get things done with limited resources.
  1. You challenge current procedures to develop other alternatives.


Agree Unsure Disagree N/A
  1. You implement changes as a result of having listened to employees
  1. You are open to the perspectives/viewpoints of others.
  1. You encourage others to adopt new procedures.
  1. You act decisively in frequently changing and uncertain environment.
  1. You are effective in incorporating new ideas.

Passion To Learn

Agree Unsure Disagree N/A
  1. You are open minded and curious about learning new skills.
  1. You are open to feedback from others.
  1. You stay up-to-date on emerging technologies.
  1. You are committed to enhancing your own knowledge and skills.
  1. You enhance your value to the company through additional training and development.

Cultural Awareness

Agree Unsure Disagree N/A
  1. You show respect in daily interactions
  1. You value the opinions of diverse groups and individual.
  1. You respect others regardless of age, race, gender, nationality, or disability.
  1. You seek out different viewpoints and benefits from different perspectives.
  1. You recognize and value individual and cultural differences.

Establishing Focus/Direction

Agree Unsure Disagree N/A
  1. You make sure that employees understand how their work relates to organizational goals.
  1. You maintain focus when handling several problems or tasks simultaneously.
  1. You make sure that employees understand and identify with the team's mission.
  1. You stay focused even when under pressure and stress.
  1. You align the department's goals with the goals of the organization.

Administrative Skill

Agree Unsure Disagree N/A
  1. You complete reports on-time.
  1. You have strong organizational skills to keep the workspace and department in order
  1. You are enthusiastic about taking on challenging projects.
  1. You have a high attention to detail.
  1. You implement and use performance measures.

Commitment To Result

Agree Unsure Disagree N/A
  1. You are able to focus on a task even when working alone.
  1. You are willing to do whatever it takes-not afraid to have to put in extra effort.
  1. You maintain persistence and dedication to achieving results.
  1. You coordinate all department activities into a cohesive team effort.
  1. You convey strong sense of own pride in Company to associates by creating a shared vision around sales and customer service.


Agree Unsure Disagree N/A
  1. You communicate goals and objectives to employees.
  1. You work toward achieving established goals and objectives.
  1. You assure [Company] principles are understood, employed & pursued.
  1. You consistently provide me with timely feedback for improving my performance.
  1. You set long-term and short-term goals.


Agree Unsure Disagree N/A
  1. You work in a way that makes others want to work with you.
  1. You are responsible for setting the vision of the department.
  1. You set a good example.
  1. Your behavior is ethical and honest.
  1. You take personal responsibility for results.

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 provide ongoing feedback to co-workers on your development progress
  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 communicate vision for the department and company.
  1. You identify root causes of problems.
  1. You analyze records and reports to obtain insight into potential issues and trends.
  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.