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 high personal standards of performance.
  1. You work in a way that makes others want to work with you.
  1. You complete assigned work tasks.
  1. You hold yourself accountable to goals / objectives
  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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  1. You pursue learning that will enhance job performance.
  1. You participate in regular training offered.
  1. You grasp new ideas, concepts, technical, or business knowledge.
  1. You take charge of your training and skills enhancement.
  1. You are open to new ideas and concepts.
Please feel free to provide any comments to help explain your answers?

Continual Improvement

Does Not
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Competency
Seldom
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Competency
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Competency
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  1. You promote training and development opportunities to enhance job performance.
  1. You look for ways to expand current job responsibilities.
  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 look for ways to improve work processes and procedures.
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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  1. You communicate with team members regarding best quality practices.
  1. I set benchmarks for quality improvements.
  1. You establish timeframes for achieving suitable quality levels.
  1. You implement standardized and data driven quality processes/procedures.
  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
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Competency
Seldom
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Competency
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Competency
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  1. You determine which tasks are critical and which tasks are optional.
  1. You ensure that assignments are prioritized according to the needs of the department/company.
  1. You keep track of multiple assignments and deadlines.
  1. You spend the most time and effort on critical tasks first.
  1. You assign tasks based on skills of team members.
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
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Competency
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Competency
  1. I views obstacles as opportunities to improve myself.
  1. I measure progress toward the goal.
  1. Completed work exceeds standards.
  1. You keep track of progress toward the results.
  1. I overcome obstacles to continue working toward goals.
Please feel free to provide any comments to help explain your answers?

Interpersonal Skills

Does Not
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Competency
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  1. You are honest about owning up to mistakes made.
  1. You strive for win/win solutions
  1. I give constructive feedback on performance reviews.
  1. I recognize when others do a good job.
  1. You believe honesty and integrity are core tenets of interpersonal relationships.
Please feel free to provide any comments to help explain your answers?

Coaching

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

Conflict Management

Does Not
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Competency
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  1. You deal effectively with employee grievances.
  1. I attentively listen to each person as they share their distinct viewpoints on the matter.
  1. You facilitate dialog between team members.
  1. You facilitate constructive dialog with stakeholders.
  1. I seek to develop a shared understanding of the issues involved.
Please feel free to provide any comments to help explain your answers?

Global Perspective

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  1. You engage in problem solving with individuals outside of the country.
  1. You consider customers point of view when making decisions.
  1. You understand and appreciate the perspectives offered by others with different cultural backgrounds.
  1. You attend training seminars and conferences to increase skills in working with others globally.
  1. You demonstrate working knowledge of global transactions.
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.