Quality - 360 Degree Feedback Survey Sample #8

Questionnaires Measuring Quality:
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 .


Agree Unsure Disagree N/A
  1. You analyze what occurred and re-adjusts accordingly when goals are not met.
  1. You reflect on what is working and what could be improved.
  1. You hold employees accountable for your quality of work.
  1. You encourage employees to produce the best quality products.
  1. You encourage others to achieve high quality standards.


Agree Unsure Disagree N/A
  1. You coach others to foster an environment which can adapt quickly and willingly to rapid change.
  1. You go above and beyond the stated goals.
  1. You take decisive action to address problems, following up with relevant team members and coaching them on how to improve.
  1. You immediately work to complete goals well before your deadline.
  1. You take action without being asked.

Commitment To Result

Agree Unsure Disagree N/A
  1. You create a sense of urgency among the store team members to complete activities, which drive sales.
  1. You take immediate action toward goals.
  1. You are willing to do whatever it takes-not afraid to have to put in extra effort.
  1. You convey strong sense of own pride in Company to associates by creating a shared vision around sales and customer service.
  1. You coordinate all department activities into a cohesive team effort.


Agree Unsure Disagree N/A
  1. You avoid creating ambiguity or mixed messages.
  1. You seek to reduce ambiguity in messaging and documents.
  1. You make sure goals and objectives are clearly and thoroughly explained and understood.
  1. You are clear about the roles and duties of team members.
  1. You maintain clarity in goals and objectives.

Managing Risk

Agree Unsure Disagree N/A
  1. You create a risk profile for projects and teams.
  1. You are concerned about process safety management.
  1. You are able to perceive the risks of different work tasks and activities.
  1. You offer training to reduce safety incidents in the workplace.
  1. You respond appropriately to unexplained or unanticipated events.


Agree Unsure Disagree N/A
  1. You treat all people fairly and with respect.
  1. You contribute to a positive and fun work environment.
  1. You show by your actions that you trust in the positive intentions of others.
  1. You build open and trusting relationships.
  1. You contribute to a positive work environment.

Supervisory Skills

Agree Unsure Disagree N/A
  1. You are aware of the unique strengths of each employee.
  1. You provide constructive, ongoing feedback.
  1. You resolve personnel problems quickly and effectively.
  1. You maintain good working relationships with employees.
  1. You treat all staff equitably.


Agree Unsure Disagree N/A
  1. You are excellent at managing relationships with stakeholders.
  1. You can work effectively in an environment of uncertainty.
  1. You have a strategic awareness on how to promote the organization.
  1. You encourage dynamic growth opportunities.
  1. You maintain a high level of energy to respond to demands of the job.


Agree Unsure Disagree N/A
  1. You develop action plans to align your work with the goals of the organization
  1. You work to support the strategy of [Company]
  1. You demonstrate consistency between words and actions
  1. You communicate the vision and strategy of [Company]
  1. You clearly articulate a vision for your work and inspires others to support it

  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.