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)

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 .

Problem Solving

Agree Unsure Disagree N/A
  1. Works cooperatively with others to solve problems.
  1. Able to balance the needs of different people in a solution to a problem.
  1. Effective in solving problems.
  1. Ability to solve problems at root cause rather than at symptom level.
  1. Is a good problem solver and decision maker


Agree Unsure Disagree N/A
  1. Suggests new ideas at meetings.
  1. Offers constructive improvements to existing systems.
  1. Builds upon the ideas and solutions of others.
  1. Challenges current procedures to develop other alternatives.
  1. Analyzes current procedures and identifies opportunities for improvement.


Agree Unsure Disagree N/A
  1. Implements changes as a result of having listened to employees
  1. Can handle changes without complaining.
  1. Effective in incorporating new ideas.
  1. Acts decisively in frequently changing and uncertain environment.
  1. Adapts to new organizational structures, policies, or procedures.

Passion To Learn

Agree Unsure Disagree N/A
  1. Critiques own performance and learns from experience as a source of continuous improvement.
  1. Holds self and associates accountable for goal achievement.
  1. Takes initiative for own learning and development.
  1. Is motivated by the desire to be "the best".
  1. Demonstrates through personal behavior the commitment to high standards of performance.

Cultural Awareness

Agree Unsure Disagree N/A
  1. Recognizes and values individual and cultural differences.
  1. Encourages a work environment where individual differences are valued.
  1. Values the opinions of diverse groups and individual.
  1. Shows respect in daily interactions
  1. Respects others regardless of age, race, gender, nationality, or disability.

Establishing Focus/Direction

Agree Unsure Disagree N/A
  1. Helps guide employees with prioritizing tasks.
  1. Excellent at managing time.
  1. Makes sure that employees understand and identify with the team's mission.
  1. Maintains focus when handling several problems or tasks simultaneously.
  1. Stays focused even when under pressure and stress.

Administrative Skill

Agree Unsure Disagree N/A
  1. Completes reports on-time.
  1. Implements and uses performance measures.
  1. Accurately implements contract provisions.
  1. Able to develop, justify and present a budget.
  1. Has strong technical/computer skills.

Commitment To Result

Agree Unsure Disagree N/A
  1. Coordinates all department activities into a cohesive team effort.
  1. Maintains persistence and dedication to achieving results.
  1. Encourages commitment in others to obtain results.
  1. Able to focus on a task even when working alone.
  1. Committed to the team.


Agree Unsure Disagree N/A
  1. Encourages me to take on greater responsibility.
  1. Consistently provides me with timely feedback for improving my performance.
  1. Works toward achieving established goals and objectives.
  1. Effectively organizes resources and plans
  1. Sets long-term and short-term goals.


Agree Unsure Disagree N/A
  1. Sets a good example.
  1. Sets high personal standards of performance.
  1. Holds herself / himself accountable to goals / objectives
  1. Is a person you can trust.
  1. Completes assigned work tasks.

Co-worker Development

Agree Unsure Disagree N/A
  1. Adapts coaching and mentoring approach to meet the style or needs of individuals
  1. Gives others development opportunities through project assignments and increased job responsibilities
  1. Provides ongoing feedback to co-workers on their development progress
  1. Sets and clearly communicates expectations, performance goals, and measurements to others

Strategic Insight

Agree Unsure Disagree N/A
  1. Communicates vision for the department and company.
  1. Identifies root causes of problems.
  1. Understands the Company's strengths and weaknesses and uses this information to create optimal solutions to problems.
  1. Formulates strategies and action plans to ensure successful completion of goals and objectives.
  1. Identifies potential problems before they become critical incidents.

  1. Overall, please rate the effectiveness of .

  2. Strengths

  3. Areas for Development

  4. Please give any final comments or suggestions for 's assessment.