Responsibility - 360 Degree Feedback Survey Sample #2





Questionnaires Measuring Responsibility:
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)
Instructions

You have been selected to provide feedback on the employee listed above. Your feedback is an important part of our company's leadership development process and this survey 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 questions below, think about your experiences working with this employee over the last twelve months and the goals they were asked to achieve. The effectiveness of this development tool is dependent on your honest, forthright and constructive responses so please bear this in mind as you answer each question. Your responses will be discussed with the employee to foster growth and on-going development.

Competencies Included:
Responsible, Emotional Intelligence, Management, Supervisory Skills, Professional Development, Persuasion and Influence, Objectives, Client Focus, Co-worker Development, Entrepreneurship, Company
Sample Result Document:
Sample Results
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.

Please ensure that your submission is made between . The survey will only be available during these dates.


Responsible

Clear
Strength
Capable
and
Effective
Could
Benefit from
Development
Needs
Significant
Improvement
  1. Is a person you can trust.
  1. Acts as a resource without removing individual responsibility.
  1. Responsible for setting the vision of the department.
  1. ...takes personal responsibility for results.
  1. Behavior is ethical and honest.
What are your suggestions for how [Participant Name] can make improvements
in Responsible?

Emotional Intelligence

Clear
Strength
Capable
and
Effective
Could
Benefit from
Development
Needs
Significant
Improvement
  1. Is able to control their own emotions.
  1. Is able to express themselves clearly.
  1. Able to understand others' points of view.
  1. Is able to manage their own emotions.
  1. Accurately perceives the emotional reactions of others.
What are your suggestions for how [Participant Name] can make improvements
in Emotional Intelligence?

Management

Clear
Strength
Capable
and
Effective
Could
Benefit from
Development
Needs
Significant
Improvement
  1. Sets an example for others to follow
  1. Delegate tasks effectively
  1. Makes you feel enthusiastic about your work
  1. Takes responsibility for things that go wrong
  1. Keep staff informed about what is happening in the company
What are your suggestions for how [Participant Name] can make improvements
in Management?

Supervisory Skills

Clear
Strength
Capable
and
Effective
Could
Benefit from
Development
Needs
Significant
Improvement
  1. Intervenes immediately if disciplinary action is warranted.
  1. Implements disciplinary policy in accordance with the union contract
  1. Provides feedback referencing specific instances or examples of behaviors.
  1. Reviews performance against established measures.
  1. Asks employees for their ideas and opinions.
What are your suggestions for how [Participant Name] can make improvements
in Supervisory Skills?

Professional Development

Clear
Strength
Capable
and
Effective
Could
Benefit from
Development
Needs
Significant
Improvement
  1. Seeks opportunities for continuous learning.
  1. Seeks opportunities for professional development.
  1. Quickly acquire and apply new knowledge and skills when needed
  1. Allows employees to fully participate in employee training and professional development.
  1. Keep themselves up-to-date of technical/professional issues
What are your suggestions for how [Participant Name] can make improvements
in Professional Development?

Persuasion and Influence

Clear
Strength
Capable
and
Effective
Could
Benefit from
Development
Needs
Significant
Improvement
  1. Has excellent influencing/negotiating skills.
  1. Attempts to persuade others rather than simply control them.
  1. Able to express own goals and needs.
  1. Understanding what others need.
  1. Ensures stakeholders are involved in the decision making process.
What are your suggestions for how [Participant Name] can make improvements
in Persuasion and Influence?

Objectives

Clear
Strength
Capable
and
Effective
Could
Benefit from
Development
Needs
Significant
Improvement
  1. Sets long-term and short-term goals.
  1. Assures [Company] principles are understood, employed & pursued.
  1. Communicates goals and objectives to employees.
  1. Organizes and schedules events, activities, and resources.
  1. Able to organize work.
What are your suggestions for how [Participant Name] can make improvements
in Objectives?

Client Focus

Clear
Strength
Capable
and
Effective
Could
Benefit from
Development
Needs
Significant
Improvement
  1. Is committed to the success of the client.
  1. Creates innovative solutions for the clients.
  1. Keeps the client informed of all progress.
  1. Able to handle difficult clients.
  1. Makes sure client needs are understood by the team members.
What are your suggestions for how [Participant Name] can make improvements
in Client Focus?

Co-worker Development

Clear
Strength
Capable
and
Effective
Could
Benefit from
Development
Needs
Significant
Improvement
  1. Gives others development opportunities through project assignments and increased job responsibilities
  1. Sets and clearly communicates expectations, performance goals, and measurements to others
  1. Takes immediate action on poor performance
  1. Adapts coaching and mentoring approach to meet the style or needs of individuals
  1. Works to identify root causes of performance problems
What are your suggestions for how [Participant Name] can make improvements
in Co-worker Development?

Entrepreneurship

Clear
Strength
Capable
and
Effective
Could
Benefit from
Development
Needs
Significant
Improvement
  1. Devotes a certain amount of time and effort to developing new business opportunities.
  1. Balances risks and rewards when making decisions.
  1. Is comfortable operating in an environment of uncertainty.
  1. Able to adapt the department to changing business demands and climate.
  1. Finds unique ways to go around barriers to success.
What are your suggestions for how [Participant Name] can make improvements
in Entrepreneurship?

Company

Clear
Strength
Capable
and
Effective
Could
Benefit from
Development
Needs
Significant
Improvement
  1. Attends [Company] gatherings and social events.
  1. Impresses upon others the important aspects of [Company].
  1. Understands the use of [Company] products and services.
  1. Expresses loyalty and dedication to [Company] in interactions with others.
  1. Follows existing procedures and processes.
What are your suggestions for how [Participant Name] can make improvements
in Company?


  1. Strengths


  2. Areas for Development


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