Responsibility - 360 Degree Feedback Survey Sample #9

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)

Thank you for providing feedback for the recipient above. As you respond, please draw on your first-hand experience with this individual in the past 12 months. Rate each item using the scale shown. If you don't feel you have enough first-hand information to rate a certain item, please choose the Not Applicable option. Comments can be very helpful; at a minimum where you give a particularly high or low rating, please share your reasons in the comment section for that competency. Your responses will be compiled with feedback from others and presented to the recipient to help guide their ongoing development.

Partially completed forms can be saved by using the Save/Still Working button at the bottom of the page. You may return at a later time to complete/edit the form. Your saved responses will be shown each time you re-visit the feedback form. When you are certain that you have completed your responses and will be not making any changes, click the Complete button.


Definite Strength Meets Standards Needs Development N/A
  1. Sets a good example
  1. Sets high personal standards of performance.
  1. Completes assigned work tasks.
  1. Works in a way that makes others want to work with her/him.
  1. ...takes personal responsibility for results.


Definite Strength Meets Standards Needs Development N/A
  1. Tells subordinates what to do, not how to do it.
  1. Sets clear and reasonable expectations for others and follows through on their progress.
  1. Allows subordinates to use their own methods and procedures.
  1. Encourages and empowers subordinates to use initiative in achieving goals and objectives.
  1. Defines the roles, responsibilities, required actions, and deadlines for team members.

Decision Making

Definite Strength Meets Standards Needs Development N/A
  1. Is able to make decisions quickly.
  1. Exercises good judgment by making sound and informed decisions.
  1. Coaches team members individually when "poor" decisions are made; helps them see what could have been done differently
  1. Assesses the risks, benefits, and potential impact of a number of options when deciding a course of action
  1. Asks for additional information when making critical decisions.

Empowering Others

Definite Strength Meets Standards Needs Development N/A
  1. Sets clear goals for others to accomplish.
  1. Distributes the workload to subordinates.
  1. Avoids micromanaging their employees.
  1. Encourages others to obtain necessary skills and training.
  1. Provides support and resources needed to accomplish goals.


Definite Strength Meets Standards Needs Development N/A
  1. Encourages collaboration with other departments.
  1. Recognizes and respects the contributions and needs of each individual.
  1. Encourages open communication
  1. Builds consensus and shares relevant information.
  1. Identifies and resolves conflicts within the team to increase team effectiveness


Definite Strength Meets Standards Needs Development N/A
  1. Creates a lot of new ideas.
  1. Adds value to the department/organization.
  1. Inspires creativity in their team.
  1. Is creative and inspirational.
  1. Is creative.


Definite Strength Meets Standards Needs Development N/A
  1. Starts meetings on time.
  1. Avoids making personal phone calls during working hours.
  1. Responds to requests for information in a timely manner.
  1. Starts the workday when scheduled.
  1. Conducts appointments at scheduled start time.


Definite Strength Meets Standards Needs Development N/A
  1. Is knowledgeable of procedures or systems necessary for the job.
  1. Knows how to produce high quality products/work.
  1. Uses expertise to identify issues and think through creative solutions to get a problem solved or objective accomplished.
  1. Seeks information from others as needed.
  1. Keeps current with technical advances within his/her professional discipline; embraces and applies new techniques and practices


Definite Strength Meets Standards Needs Development N/A
  1. Maintains clarity in goals and objectives.
  1. Avoids stating unclear or conflicting goals.
  1. Checks details thoroughly.
  1. Makes sure goals and objectives are clearly and thoroughly explained and understood.
  1. Attends to the important details of a job or task.

Organizational Fluency

Definite Strength Meets Standards Needs Development N/A
  1. Gets things done through the department.
  1. Able to explain departmental policies and procedures to others.
  1. Understands departmental policies and procedures.
  1. Able to use corporate politics to advance department objectives.
  1. Anticipates problems that may affect the department.

  1. Overall, please rate the effectiveness of .

  2. Strengths

  3. Areas for Development

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