Responsibility - 360 Degree Feedback Survey Sample #11

360 Feedback Survey

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)

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.

To what extent does [Participant Name] exhibit the following ...

SELECT the rating that best reflects the employee's performance in the areas listed.


What does Responsible mean?
It means that ...
  • Your behavior is ethical and honest.
  • You set a good example
  • You hold yourself accountable to goals / objectives
  • You are a person others can trust.
  • You set high personal standards of performance.

To what extent does this person exhibit Responsible?
Select from one of the ratings below.


What does Excellence mean?
It means that ...
  • You keep yourself and others focused on constant improvement.
  • You can be counted on to add value wherever you are involved.
  • You demonstrate the functional or technical skills necessary to do your job.
  • You are planful and organized.
  • You take a lot of pride in your work.

To what extent does this person exhibit Excellence?
Select from one of the ratings below.

Continual Learning

What does Continual Learning mean?
It means that ...
  • You improve on your skill sets.
  • You take the initiative to learn new skills.
  • You are open to new ideas and concepts.
  • You set relevant learning objectives and goals.
  • You share best practices with others and learn from others.

To what extent does this person exhibit Continual Learning?
Select from one of the ratings below.


What does Delegation mean?
It means that ...
  • You define the roles, responsibilities, required actions, and deadlines for team members.
  • You encourage and empower subordinates to use initiative in achieving goals and objectives.
  • You entrust subordinates with important tasks.
  • You tell subordinates what to do, not how to do it.
  • You allow employees to decide how they wish to complete the tasks.

To what extent does this person exhibit Delegation?
Select from one of the ratings below.

Global Perspective

What does Global Perspective mean?
It means that ...
  • You consider customers point of view when making decisions.
  • You accept setbacks and challenges in foreign markets as improvement opportunities
  • 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.
  • You demonstrate working knowledge of global transactions.
  • You apply knowledge of overseas markets.

To what extent does this person exhibit Global Perspective?
Select from one of the ratings below.

Areas for Development

Please give any final comments or suggestions for [Participant Name Here]'s assessment.