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
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Competency
Sometimes
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Competency
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Competency
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Exhibits this
Competency
  1. You set a good example.
  1. You work in a way that makes others want to work with you.
  1. You set a good example
  1. You set high personal standards of performance.
  1. Your behavior is ethical and honest.
Please feel free to provide any comments to help explain your answers?

Continual Learning

Does Not
Exhibit this
Competency
Seldom
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Competency
Sometimes
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Competency
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Competency
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Competency
  1. I view setbacks as opportunities to learn from.
  1. You are open to new ideas and concepts.
  1. You grasp new ideas, concepts, technical, or business knowledge.
  1. You participate in regular training offered.
  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
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Competency
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Competency
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Competency
  1. You look for ways to expand current job responsibilities.
  1. You promote training and development opportunities to enhance job performance.
  1. You encourage an employee culture of continuous improvement to seek out better ways of doing things.
  1. You search for new methods, techniques, and processes that increase efficiency and reduce costs.
  1. You are open to the suggestions from others.
Please feel free to provide any comments to help explain your answers?

Quality

Does Not
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Competency
Seldom
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Competency
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Competency
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Competency
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Competency
  1. You are able to anticipate quality issues and take preventative actions.
  1. You provide regular and timely feedback on quality levels.
  1. You implement standardized and data driven quality processes/procedures.
  1. You effectively work with Quality Control (QC) engineers.
  1. You develop and maintains quality control checklists for the manufacturing department.
Please feel free to provide any comments to help explain your answers?

Juggling Multiple Responsibilities

Does Not
Exhibit this
Competency
Seldom
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Competency
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Competency
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Competency
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  1. You observe, analyze, and respond to merchandise needs while serving customers and accomplishing operational tasks.
  1. You complete multiple tasks simultaneously.
  1. You determine which tasks are critical and which tasks are optional.
  1. You assess current capabilities before committing to new requests from customers.
  1. You build in extra time in the schedule for unplanned events/occurrences.
Please feel free to provide any comments to help explain your answers?

Results Oriented

Does Not
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Competency
Seldom
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Competency
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Competency
Usually
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Competency
Always
Exhibits this
Competency
  1. You are a high achiever.
  1. You complete work on time.
  1. I set benchmarks and milestones to measure progress toward the objectives.
  1. I achieve long and short-term goals.
  1. I complete all required coursework.
Please feel free to provide any comments to help explain your answers?

Interpersonal Skills

Does Not
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Competency
Seldom
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Competency
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Competency
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Competency
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Competency
  1. You create an atmosphere that supports the open expression of ideas
  1. I appreciate the extra efforts made by coworkers.
  1. I give credit where credit is due.
  1. I respond quickly to inquiries from potential customers.
  1. I pay close attention to what is being communicated verbally and nonverbally.
Please feel free to provide any comments to help explain your answers?

Coaching

Does Not
Exhibit this
Competency
Seldom
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Competency
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Competency
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Competency
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Competency
  1. You coach employees in how to strengthen knowledge and skills to improve work performance.
  1. You conduct regular performance appraisals and feedback.
  1. You provide clear, motivating, and constructive feedback.
  1. You develop the skills and capabilities of others.
  1. You meet regularly with employees to coach them on areas that will enhance your performance
Please feel free to provide any comments to help explain your answers?

Conflict Management

Does Not
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Competency
Seldom
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Competency
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  1. I facilitate the resolution of grievances by fostering mutual understanding and appreciation of each party's needs.
  1. I ensure that all team members feel respected and heard.
  1. I steer the process towards compromise and conflict resolution.
  1. I ensure that the basic needs of each party are satisfied.
  1. I work to settle conflicts in a manner that is acceptable for a long-term solution.
Please feel free to provide any comments to help explain your answers?

Global Perspective

Does Not
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Competency
Seldom
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Competency
Sometimes
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Competency
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Competency
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Competency
  1. You understand and appreciate the perspectives offered by others with different cultural backgrounds.
  1. You accept setbacks and challenges in foreign markets as improvement opportunities
  1. You develop both the cultural awareness and business skills to grow our business in all countries, and work effectively across borders with employees, customers, and shareowners.
  1. You align personal vision with global strategies.
  1. You are able to work with individuals having different backgrounds and cultures.
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.