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)
Survey 10 (Comment boxes only)
Survey 11 (Single rating per competency)
Survey 12 (Slide-bar scale)

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.

Sample Result Document:
Sample Results
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. Is aware of personal impact on others and adjusts behavior to create a positive leadership presence.
  1. Uses patience and self-control in working with customers and associates.
  1. Sets an example for associates during stressful periods by maintaining a positive, can-do attitude.
  1. Analyzes own reactions on the spot to ensure that communication does not appear to be driven by anger.

Continual Improvement

Agree Unsure Disagree N/A
  1. Looks for ways to improve work processes and procedures.
  1. Analyzes processes to determine areas for improvement.
  1. Looks for ways to expand current job responsibilities.
  1. Searches for new methods, techniques, and processes that increase efficiency and reduce costs.
  1. Promotes training and development opportunities to enhance job performance.

Supervisory Skills

Agree Unsure Disagree N/A
  1. Resolves personnel problems quickly and effectively.
  1. Maintains good working relationships with employees.
  1. Delegates effectively.
  1. Provides constructive, ongoing feedback.
  1. Promotes teamwork and cooperation within the department.


Agree Unsure Disagree N/A
  1. ...Overall Performance
  1. Works effectively in the department.
  1. Sets a high standard for job performance.
  1. Shown significant improvement in job performance.
  1. Works well in this position.

Administrative Skill

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


Agree Unsure Disagree N/A
  1. Keeps supervisor informed of recent events.
  1. Acts like an owner when they make decisions.
  1. Implements and facilitates controls and processes that maintain the integrity of the organization.
  1. Takes ownership of mistakes and learns from them.
  1. Defines roles, rights, and responsibilities of the team.


Agree Unsure Disagree N/A
  1. Establishes and documents goals and objectives.
  1. Sets high expectations and goals; encourages others to support the organization.
  1. Makes sure that I have a clear idea of our group's goals.
  1. Conducts timely follow-up; keeps others informed on a need to know basis.
  1. Achieves goals.


Agree Unsure Disagree N/A
  1. Is knowledgeable of procedures or systems necessary for the job.
  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
  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.


Agree Unsure Disagree N/A
  1. Builds and maintains the trust of others.
  1. Delivers on promises made.
  1. Takes care to maintain confidential information.
  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. Assists team members by helping them see the other point of view.
  1. Tries to understand others' point of view before making judgments
  1. Helps employees to think through alternative ways to resolve conflict situations.
  1. Deals effectively with employee grievances.
  1. Identifies and takes steps to prevent potential confrontations.


Agree Unsure Disagree N/A
  1. Coaches team members
  1. Contributes to and supports team decision-making process
  1. Actively and openly participates in group meetings.
  1. Encourages collaboration with other departments.
  1. Communicates well with team members.


Agree Unsure Disagree N/A
  1. Takes the initiative to complete tasks.
  1. Devotes a certain amount of time and effort to developing new business opportunities.
  1. Understands the processes and various stages of business development.
  1. Excellent at managing relationships with stakeholders.
  1. Is comfortable operating in an environment of uncertainty.

  1. Overall, please rate the effectiveness of [Participant Name Here].

  2. Strengths

  3. Areas for Development

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