Self-Management - 360 Degree Feedback Survey Sample #8

Questionnaires Measuring Self-Management:
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 .

Self Management

Agree Unsure Disagree N/A
  1. Does not allow own emotions to interfere with the performance of others.
  1. Analyzes own reactions on the spot to ensure that communication does not appear to be driven by anger.
  1. Deals with conflict by controlling own emotions by listening, being flexible, and sincere in responding.
  1. Consciously controls own negative emotions in order to keep team morale up.
  1. Sets an example for associates during stressful periods by maintaining a positive, can-do attitude.

Continual Improvement

Agree Unsure Disagree N/A
  1. Open to the suggestions from others.
  1. Looks for ways to expand current job responsibilities.
  1. Promotes training and development opportunities to enhance job performance.
  1. Looks for ways to improve work processes and procedures.
  1. Looks for ways to expand and learn new job skills.

Supervisory Skills

Agree Unsure Disagree N/A
  1. Delegates effectively.
  1. Encourages employees to achieve their full potential.
  1. Resolves personnel problems quickly and effectively.
  1. Treats all staff equitably.
  1. Provides constructive, ongoing feedback.


Agree Unsure Disagree N/A
  1. ...Overall Performance
  1. Works well in this position.
  1. Effectively organizes resources and plans
  1. Sets a high standard for job performance.
  1. Listens and responds to issues and problems

Administrative Skill

Agree Unsure Disagree N/A
  1. Has strong technical/computer skills.
  1. High attention to detail.
  1. Strong organizational skills to keep the workspace and department in order
  1. Enthusiastic about taking on challenging projects.
  1. Takes responsibility for decisions.


Agree Unsure Disagree N/A
  1. Keeps supervisor informed of recent events.
  1. Defines roles, rights, and responsibilities of employees.
  1. Defines roles, rights, and responsibilities of the team.
  1. Takes responsibility for results.
  1. Implements and facilitates controls and processes that maintain the integrity of the organization.


Agree Unsure Disagree N/A
  1. Sets high expectations and goals; encourages others to support the organization.
  1. Understands & contributes to development of strategic goals.
  1. Makes sure that team members have a clear idea of our group's goals.
  1. Goal Setting
  1. Establishes and documents goals and objectives.


Agree Unsure Disagree N/A
  1. Is naturally sought out by people outside his/her particular area for advice and opinion on a broad range of matters - not necessarily solely legal advice.
  1. Willingly shares his/her technical expertise; sought out as resource by others
  1. Uses expertise to identify issues and think through creative solutions to get a problem solved or objective accomplished.
  1. Knows how to produce high quality products/work.
  1. Keeps current with technical advances within his/her professional discipline; embraces and applies new techniques and practices


Agree Unsure Disagree N/A
  1. Takes ownership, delivers on commitments
  1. Communicates an understanding of the other person's interests, needs and concerns.
  1. Delivers on promises made.
  1. Works in a way that makes others want to work with her/him.
  1. Is trustworthy; is someone I can trust.

Conflict Management

Agree Unsure Disagree N/A
  1. Clearly expresses expectations to others.
  1. Discusses conflict situations with supervisor.
  1. Tries to understand others' point of view before making judgments
  1. Identifies and takes steps to prevent potential confrontations.
  1. Helps employees to think through alternative ways to resolve conflict situations.


Agree Unsure Disagree N/A
  1. Builds relationships across boundaries and with key stakeholders by developing informal and formal networks.
  1. Encourages others to share ideas to develop team cohesion
  1. Encourages teamwork and collaboration.
  1. Willingly share their technical expertise
  1. Relates to all kinds of people tactfully


Agree Unsure Disagree N/A
  1. Excellent at managing relationships with stakeholders.
  1. Finds unique ways to go around barriers to success.
  1. Has a strategic awareness on how to promote the organization.
  1. Encourages risk taking for developing potential business opportunities.
  1. Able to adapt the department to changing business demands and climate.

  1. Overall, please rate the effectiveness of .

  2. Strengths

  3. Areas for Development

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