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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)
Survey 13 (4-point scale; numbers; floating anchors)
Survey 14 (4-point scale; N/A)
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.



Edit this Survey
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Responsible

Does Not
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Competency
Seldom
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Competency
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Competency
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  1. You set a good example.
  1. You take personal responsibility for results.
  1. You are a person others can trust.
  1. You set a good example
  1. You hold yourself accountable to goals / objectives
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
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Competency
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  1. You take the initiative to learn new skills.
  1. I view setbacks as opportunities to learn from.
  1. You participate in regular training offered.
  1. You build on your strengths while addressing your weaknesses.
  1. You take charge of your training and skills enhancement.
Please feel free to provide any comments to help explain your answers?

Continual Improvement

Does Not
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Competency
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  1. You look for ways to improve work processes and procedures.
  1. You search for new methods, techniques, and processes that increase efficiency and reduce costs.
  1. You are open to the suggestions from others.
  1. You look for ways to expand current job responsibilities.
  1. I foster a culture of open communication and continuous improvement.
Please feel free to provide any comments to help explain your answers?

Quality

Does Not
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  1. I influence others to achieve high quality standards.
  1. You consistently provide timely, accurate, and reliable information on quality measures.
  1. I respond to issues immediately.
  1. You develop a quality manual to assist in troubleshooting issues and documenting the quality management system.
  1. You promote quality improvement practices in the department.
Please feel free to provide any comments to help explain your answers?

Juggling Multiple Responsibilities

Does Not
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Competency
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Competency
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  1. You begin tasks as soon as possible.
  1. You assess current capabilities before committing to new requests from customers.
  1. You determine which tasks are critical and which tasks are optional.
  1. You build in extra time in the schedule for unplanned events/occurrences.
  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
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Competency
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  1. I review historical performance data to inform future planning decisions.
  1. You use encouraging language to uplift team morale during difficult phases.
  1. You work toward achievement of goals even when confronted with obstacles.
  1. I clearly define roles and expectations.
  1. You identify the steps needed to accomplish the results.
Please feel free to provide any comments to help explain your answers?

Interpersonal Skills

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Competency
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  1. You anticipate the concerns of other employees.
  1. You give good advice and suggestions to coworkers.
  1. You understand the core issues of conversations.
  1. You use tact, compassion, and sensitivity in interactions with others.
  1. You come across as credible, knowledgeable and sincere
Please feel free to provide any comments to help explain your answers?

Coaching

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Competency
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Competency
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Competency
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  1. You encourage the employee to consider other points of view.
  1. I offer coaching that has a maximum impact on the employee.
  1. I create a culture where employees feel comfortable discussing challenges without fear of judgment.
  1. You ask questions to clarify the employee intentions or motives.
  1. You provide guidance and feedback to help accomplish a task or solve a problem.
Please feel free to provide any comments to help explain your answers?

Conflict Management

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  1. You develop long-term methods for address conflicts.
  1. You apply diagnostic thinking to interpersonal tensions, identifying whether the issue stems from values, roles, goals, or procedures.
  1. You reframe conflicts as opportunities to innovate and create new solutions to problems.
  1. I actively engage both parties to voluntarily collaborate and resolve their differences.
  1. You identify areas of agreement and common ground to form basis of resolution.
Please feel free to provide any comments to help explain your answers?

Global Perspective

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Competency
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  1. You analyze global issues/problems that are having a large impact on the Company.
  1. You consider customers point of view when making decisions.
  1. You engage in problem solving with individuals outside of the country.
  1. You can effectively deliver presentations to international clients.
  1. You respect individual differences.
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.