Recognition- 360 Degree Feedback Survey Sample #11

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.

To what extent does [Participant Name] exhibit the following ...

SELECT the rating that best reflects the employee's performance in the areas listed.


What does Recognition mean?
It means that ...
  • You recognize the abilities and skills of self and others
  • You recognize individuals for a specific outstanding achievement.
  • You find opportunities to recognize others.
  • You reinforce and reward employees for accomplishing necessary goals.
  • You are sincerely interested in the suggestions of co-workers

To what extent does this person exhibit Recognition?
Select from one of the ratings below.

Managing Performance

What does Managing Performance mean?
It means that ...
  • You use timely and appropriate corrective/disciplinary actions.
  • You examine the most effective ways for accomplishing goals.
  • You review job performance shortly after completion of tasks.
  • You obtain commitment from employees regarding completion of tasks.
  • You set specific and measurable goals for others and follows through to completion.

To what extent does this person exhibit Managing Performance?
Select from one of the ratings below.

Change Management

What does Change Management mean?
It means that ...
  • You work cooperatively with others to implement changes.
  • You adopt changes to set and example for others to follow.
  • You assist others in understanding changes to the organization.
  • You support new initiatives for organizational changes to improve effectiveness.
  • You are effective in dealing with ambiguous and challenging situations.

To what extent does this person exhibit Change Management?
Select from one of the ratings below.

Conflict Management

What does Conflict Management mean?
It means that ...
  • You identify and takes steps to prevent potential confrontations.
  • You assist team members by helping them see the other point of view.
  • You clearly express expectations to others.
  • You try to understand others' point of view before making judgments
  • You discuss conflict situations with supervisor.

To what extent does this person exhibit Conflict Management?
Select from one of the ratings below.

Customer Focus

What does Customer Focus mean?
It means that ...
  • You develop strong customer relationships.
  • You ensure all customer commitments and requirements are met or exceeded.
  • You maintain positive customer relationships.
  • You consistently model positive customer service attitudes.
  • You ask questions and listen carefully to determine customer needs and to ensure that the customer's needs are met.

To what extent does this person exhibit Customer Focus?
Select from one of the ratings below.

Areas for Development

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