Recognition- 360 Degree Feedback Survey Sample #10

360 Feedback Survey

Assessments Measuring Recognition:
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)

Thank you for providing feedback for the recipient above. As you respond, please draw on your first-hand experience with this individual in the past 12 months. Rate each item using the scale shown. If you don't feel you have enough first-hand information to rate a certain item, please choose the Not Applicable option. Comments can be very helpful; at a minimum where you give a particularly high or low rating, please share your reasons in the comment section for that competency. Your responses will be compiled with feedback from others and presented to the recipient to help guide their ongoing development.

Partially completed forms can be saved by using the Save/Still Working button at the bottom of the page. You may return at a later time to complete/edit the form. Your saved responses will be shown each time you re-visit the feedback form. When you are certain that you have completed your responses and will be not making any changes, click the Complete button.


  • Recognizes individuals for a specific outstanding achievement.
  • Says "thank you" to show appreciation for work of others.
  • Lets employees know when they have done well
  • Makes people around them feel appreciated and valued.
  • Recognizes team members who offer a significant contribution to a project.
If [Participant Name] were to make improvements in Recognition, what are your suggestions for how he/she can improve this?

Cultural Awareness

  • Is willing to include individuals with different cultural backgrounds on the team.
  • Develops skills and attitudes to bridge cultural differences.
  • Seeks clarification to avoid misunderstandings.
  • Views diversity as a strength, not as an issue.
  • Values the opinions of diverse groups and individual.
If [Participant Name] were to make improvements in Cultural Awareness, what are your suggestions for how he/she can improve this?


  • Is planful and organized.
  • Keeps themselves and others focused on constant improvement.
  • Produces high quality work.
  • Takes a lot of pride in their work.
  • Can be counted on to add value wherever they are involved.
If [Participant Name] were to make improvements in Excellence, what are your suggestions for how he/she can improve this?


  • Helps employees to understand responsibilities, authority, and expectations.
  • Addresses employee behavior problems effectively.
  • Coaches employees in how to strengthen knowledge and skills to improve work performance.
  • Helps employees to maintain high personal standards.
  • Develops the skills and capabilities of others.
If [Participant Name] were to make improvements in Coaching, what are your suggestions for how he/she can improve this?


  • Impresses upon others the important aspects of [Company].
  • Understands the use of [Company] products and services.
  • Understands how decisions impact other business units beyond their immediate department of work group.
  • Expresses loyalty and dedication to [Company] in interactions with others.
  • Follows existing procedures and processes.
If [Participant Name] were to make improvements in Company, what are your suggestions for how he/she can improve this?
Overall, please rate the effectiveness of [Participant Name Here].


Areas for Development

Please give any final comments or suggestions for [Participant Name Here]'s assessment.