Responsibility - 360 Degree Feedback Survey Sample #8

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)

You have been selected to provide feedback for the manager listed above. Your feedback is an important part of 's leadership development process. This tool 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 assessment form, please think about your experiences working with this individual during the last six to twelve months. Your responses will be merged with other people's feedback and presented to to guide them in their on-going development. Comments will be shared anonymously, as written, with the manager.

Method of use: As part of the review process, managers will receive feedback from peers and staff. It is recognized that not all participants will be able to assess an individual's performance in all areas. The feedback received will be utilized as input to the manager's performance and on-going development plan.

You may sign out at any time by pressing the Save button at the end of the form and then closing your browser. You may return later to pick up where you left off. When you are done, press the Complete button.

When clicking your selection below, try to best fit the manager's actual behaviors to the scale provided.

If you are not sure, or unable to assess, select "Not Applicable" (N/A) option.

Please complete your response by .


Agree Unsure Disagree N/A
  1. Is a person you can trust.
  1. Sets a good example
  1. Behavior is ethical and honest.
  1. ...takes personal responsibility for results.
  1. Sets high personal standards of performance.

Interpersonal Skills

Agree Unsure Disagree N/A
  1. Values the opinions of others.
  1. Is a role model for others
  1. Demonstrates willingness to work with others.
  1. Provides constructive feedback in a way that fosters acceptance and development.
  1. Uses tact, compassion, and sensitivity in interactions with others.


Agree Unsure Disagree N/A
  1. Helps employees to understand responsibilities, authority, and expectations.
  1. Meets regularly with employees to coach them on areas that will enhance their performance
  1. Coaches employees in how to strengthen knowledge and skills to improve work performance.
  1. Addresses employee behavior problems effectively.
  1. Provides clear, motivating, and constructive feedback.


Agree Unsure Disagree N/A
  1. Adapts to new organizational structures, policies, or procedures.
  1. Works effectively during periods of change.
  1. Willing to try new ideas.
  1. Implements changes as a result of having listened to employees
  1. Is open to alternative ways to accomplish goals


Agree Unsure Disagree N/A
  1. Corrects issues in a timely manner.
  1. Always strives to produce the highest quality work products.
  1. Analyze what occurred and re-adjusts accordingly when goals are not met.
  1. Reflects on what is working and what could be improved.
  1. Encourages employees to produce the best quality products.

Problem Solving

Agree Unsure Disagree N/A
  1. Is a good problem solver and decision maker
  1. Ability to develop innovative solutions to problems.
  1. Effective in solving problems.
  1. Able to balance the needs of different people in a solution to a problem.
  1. Ability to solve problems at root cause rather than at symptom level.

Results Oriented

Agree Unsure Disagree N/A
  1. Stays focused on meeting the needs of customers.
  1. Encourages a high-energy, fun work environment and coaches others on how to do the same
  1. Directs team in prioritizing daily work activities
  1. Does not become distracted by non-issues or interruptions.
  1. Inspires and motivates co-workers to be productive and energetic at work


Agree Unsure Disagree N/A
  1. ...treats others with respect and dignity.
  1. Treats others with respect and dignity.
  1. Able to see issues from others' perspectives.
  1. Works across boundaries within the organization.
  1. Forms working relationships with employees from other departments.

Global Perspective

Agree Unsure Disagree N/A
  1. Understands how cultures differ and how these differences impact work behavior.
  1. Aligns personal vision with global strategies.
  1. Accepts setbacks and challenges in foreign markets as improvement opportunities
  1. Demonstrates working knowledge of global transactions.
  1. Can effectively deliver presentations to international clients.

  1. Overall, please rate the effectiveness of .

  2. Strengths

  3. Areas for Development

  4. Please give any final comments or suggestions for 's assessment.