Responsibility - 360 Degree Feedback Survey Sample #3





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)
Self-Assessment Instructions

Leadership at [Company] are participating in a 360-Degree Feedback assessment. As part of this process, you need to complete a self-assessment questionnaire form. Other employees, including your manager(s), peers, and direct reports will also evaluate you. In this manner, you will be provided with a comprehensive, multi-perspective (i.e., 360-degree) view of your performance as a manager. The objective is to provide you with feedback so as to allow you to improve your performance, resulting in improved team performance, and organizational effectiveness.

If you are not able to respond to an item, leave it blank and go on to the next item.

Competencies Included:
Responsible, Continual Learning, Continual Improvement, Quality, Juggling Multiple Responsibilities, Results Oriented, Interpersonal Skills, Coaching, Conflict Management, Global Perspective
Sample Result Document:
Sample Results
We encourage everyone to complete the survey. Please be honest, constructive and thoughtful in your input. The survey is designed to help us understand more about your thoughts and needs to make this a great company.

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




Responsible

Does Not
Exhibit this
Competency
Seldom
Exhibits this
Competency
Sometimes
Exhibits this
Competency
Usually
Exhibits this
Competency
Always
Exhibits this
Competency
  1. You are a person others can trust.
  1. You set a good example
  1. You act as a resource without removing individual responsibility.
  1. You set a good example.
  1. You work in a way that makes others want to work with you.
Please feel free to provide any comments to help explain your answers?

Continual Learning

Does Not
Exhibit this
Competency
Seldom
Exhibits this
Competency
Sometimes
Exhibits this
Competency
Usually
Exhibits this
Competency
Always
Exhibits this
Competency
  1. You are open to new ideas and concepts.
  1. You participate in regular training offered.
  1. You take the initiative to learn new skills.
  1. You build on your strengths while addressing your weaknesses.
  1. You pursue self-improvement through continual learning.
Please feel free to provide any comments to help explain your answers?

Continual Improvement

Does Not
Exhibit this
Competency
Seldom
Exhibits this
Competency
Sometimes
Exhibits this
Competency
Usually
Exhibits this
Competency
Always
Exhibits this
Competency
  1. You look for ways to expand current job responsibilities.
  1. You search for new methods, techniques, and processes that increase efficiency and reduce costs.
  1. You encourage an employee culture of continuous improvement to seek out better ways of doing things.
  1. You are open to the suggestions from others.
  1. You look for ways to expand and learn new job skills.
Please feel free to provide any comments to help explain your answers?

Quality

Does Not
Exhibit this
Competency
Seldom
Exhibits this
Competency
Sometimes
Exhibits this
Competency
Usually
Exhibits this
Competency
Always
Exhibits this
Competency
  1. You always strive to produce the highest quality work products.
  1. You encourage others to achieve high quality standards.
  1. You correct issues in a timely manner.
  1. You hold employees accountable for your quality of work.
  1. You analyze what occurred and re-adjusts accordingly when goals are not met.
Please feel free to provide any comments to help explain your answers?

Juggling Multiple Responsibilities

Does Not
Exhibit this
Competency
Seldom
Exhibits this
Competency
Sometimes
Exhibits this
Competency
Usually
Exhibits this
Competency
Always
Exhibits this
Competency
  1. You are aware of the deadlines for specific tasks/assignments.
  1. You complete multiple tasks simultaneously.
  1. You assign tasks based on skills of team members.
  1. You rank the importance of tasks to make sure critical tasks are completed first.
  1. You plan and organize continuously while performing all other responsibilities and activities.
Please feel free to provide any comments to help explain your answers?

Results Oriented

Does Not
Exhibit this
Competency
Seldom
Exhibits this
Competency
Sometimes
Exhibits this
Competency
Usually
Exhibits this
Competency
Always
Exhibits this
Competency
  1. You encourage employees to give 100% to achieving high results.
  1. You identify the steps needed to accomplish the results.
  1. I determine what resources will be needed to achieve the objectives.
  1. You encourage a high-energy, fun work environment and coaches others on how to do the same
  1. I prioritize tasks to best achieve the results.
Please feel free to provide any comments to help explain your answers?

Interpersonal Skills

Does Not
Exhibit this
Competency
Seldom
Exhibits this
Competency
Sometimes
Exhibits this
Competency
Usually
Exhibits this
Competency
Always
Exhibits this
Competency
  1. I value the input from coworkers.
  1. I demonstrate positive behaviors for others to follow.
  1. I promote acceptance of diverse viewpoints from team members.
  1. You adapt management style to meet the needs of the individual or situation.
  1. You provide constructive feedback in a way that fosters acceptance and development.
Please feel free to provide any comments to help explain your answers?

Coaching

Does Not
Exhibit this
Competency
Seldom
Exhibits this
Competency
Sometimes
Exhibits this
Competency
Usually
Exhibits this
Competency
Always
Exhibits this
Competency
  1. You meet regularly with employees to coach them on areas that will enhance your performance
  1. You provide clear, motivating, and constructive feedback.
  1. You conduct regular performance appraisals and feedback.
  1. You help employees to maintain high personal standards.
  1. You coach employees in how to strengthen knowledge and skills to improve work performance.
Please feel free to provide any comments to help explain your answers?

Conflict Management

Does Not
Exhibit this
Competency
Seldom
Exhibits this
Competency
Sometimes
Exhibits this
Competency
Usually
Exhibits this
Competency
Always
Exhibits this
Competency
  1. You identify and takes steps to prevent potential confrontations.
  1. You discuss conflict situations with supervisor.
  1. You clearly express expectations to others.
  1. You assist team members by helping them see the other point of view.
  1. You help employees to think through alternative ways to resolve conflict situations.
Please feel free to provide any comments to help explain your answers?

Global Perspective

Does Not
Exhibit this
Competency
Seldom
Exhibits this
Competency
Sometimes
Exhibits this
Competency
Usually
Exhibits this
Competency
Always
Exhibits this
Competency
  1. You understand how cultures differ and how these differences impact work behavior.
  1. You can effectively deliver presentations to international clients.
  1. You are aware of the culture, behaviors, identities and beliefs of others.
  1. You apply knowledge of overseas markets.
  1. You engage in problem solving with individuals outside of the country.
Please feel free to provide any comments to help explain your answers?

  1. Overall, please rate the effectiveness of [Participant Name].






  2. Strengths


  3. Areas for Development


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