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 work in a way that makes others want to work with you.
  • You take personal responsibility for results.
  • You act as a resource without removing individual responsibility.
  • You complete assigned work tasks.

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


What does Excellence mean?
It means that ...
  • You take a lot of pride in your work.
  • You keep yourself and others focused on constant improvement.
  • You can be counted on to add value wherever you are involved.
  • You are planful and organized.
  • You produce high quality 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 build on your strengths while addressing your weaknesses.
  • You are open to new ideas and concepts.
  • You set relevant learning objectives and goals.
  • I view setbacks as opportunities to learn from.

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


What does Delegation mean?
It means that ...
  • You allow employees to decide how they wish to complete the tasks.
  • You tell subordinates what to do, not how to do it.
  • You allow subordinates to use their own methods and procedures.
  • You delegate tasks, responsibilities, and accountability as appropriate to the level of employee.
  • You encourage and empower subordinates to use initiative in achieving goals and objectives.

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 cooperate with others on a global scale.
  • You demonstrate a curiosity about diverse individuals and cultures.
  • You understand how cultures differ and how these differences impact work behavior.
  • You are aware of the culture, behaviors, identities and beliefs of others.
  • You collaborate with others respectfully and effectively with other people regardless of differences in cultural backgrounds.

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.