Trustworthy - 360 Degree Feedback Survey Sample #3





Questionnaires Measuring Trustworthy:
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)
Survey 13 (4-point scale; numbers; floating anchors)
Survey 14 (4-point scale; N/A)
Instructions

You have been asked to evaluate yourself as part of a 360-degree feedback process. Other employees, including your manager(s), peers, and direct reports will also evaluate you. In this manner, you will be provided with a comprehensive, multi-perspective (i.e., 360-degree) view of your performance as a manager. The objective is to provide you with feedback so as to allow you to improve your performance, resulting in improved team performance, and organizational effectiveness.

If you are not able to respond to an item, leave it blank and go on to the next item.

Sample Result Document:
Sample Results
We encourage everyone to complete the survey. Please be honest, constructive and thoughtful in your input. The survey is designed to help us understand more about your thoughts and needs to make this a great company.

Please ensure that your submission is made between . The survey will only be available during these dates.







Trustworthy

Does Not
Exhibit this
Competency
Seldom
Exhibits this
Competency
Sometimes
Exhibits this
Competency
Usually
Exhibits this
Competency
Always
Exhibits this
Competency
  1. Delivers on promises made.
  1. Communicates an understanding of the other person's interests, needs and concerns.
  1. Consistently keeps commitments.
  1. Demonstrates a sense of responsibility and commitment to public trust.
  1. Takes care to maintain confidential information.
Please feel free to provide any comments to help explain your answers?

Interpersonal Skills

Does Not
Exhibit this
Competency
Seldom
Exhibits this
Competency
Sometimes
Exhibits this
Competency
Usually
Exhibits this
Competency
Always
Exhibits this
Competency
  1. Attends to both the content and the context of what was being said.
  1. Recognizes when others do a good job.
  1. Is a role model for others demonstrating the importance of interpersonal skills.
  1. Demonstrates willingness to work with others.
  1. Considers the other individual's point of view.
Please feel free to provide any comments to help explain your answers?

Adaptability

Does Not
Exhibit this
Competency
Seldom
Exhibits this
Competency
Sometimes
Exhibits this
Competency
Usually
Exhibits this
Competency
Always
Exhibits this
Competency
  1. Embraces change and fosters an open-minded environment.
  1. Adjusts tactics and strategies.
  1. Able to adjust to changes as needed.
  1. Willing to change ideas or perceptions based on new information or contrary evidence which is presented.
  1. Is aware of changes to the policies and procedures.
Please feel free to provide any comments to help explain your answers?

Creativity

Does Not
Exhibit this
Competency
Seldom
Exhibits this
Competency
Sometimes
Exhibits this
Competency
Usually
Exhibits this
Competency
Always
Exhibits this
Competency
  1. Adds value to the department/organization.
  1. Is creative.
  1. Creates a lot of new ideas.
  1. Is creative and inspirational.
  1. Conceives, implements and evaluates ideas.
Please feel free to provide any comments to help explain your answers?

Passion To Learn

Does Not
Exhibit this
Competency
Seldom
Exhibits this
Competency
Sometimes
Exhibits this
Competency
Usually
Exhibits this
Competency
Always
Exhibits this
Competency
  1. Inspires others to learn new things.
  1. Takes advantage of training opportunities when they arise.
  1. Is open to feedback from others.
  1. Embraces new technology and procedures.
  1. Enjoys learning new skills and techniques.
Please feel free to provide any comments to help explain your answers?

Continual Learning

Does Not
Exhibit this
Competency
Seldom
Exhibits this
Competency
Sometimes
Exhibits this
Competency
Usually
Exhibits this
Competency
Always
Exhibits this
Competency
  1. Seeks opportunities to grow in skills and knowledge.
  1. Shares best practices with others and learns from others.
  1. Improves on their skill sets.
  1. Participates in regular training offered.
  1. Grasps new ideas, concepts, technical, or business knowledge.
Please feel free to provide any comments to help explain your answers?

Quality

Does Not
Exhibit this
Competency
Seldom
Exhibits this
Competency
Sometimes
Exhibits this
Competency
Usually
Exhibits this
Competency
Always
Exhibits this
Competency
  1. Provides advice and guidance to team members on improving quality controls.
  1. Sets benchmarks for quality improvements.
  1. Develops specific quality standards/goals to be met within a specified timeframe.
  1. Holds employees accountable for their quality of work.
  1. Quickly addresses changes in quality of the products.
Please feel free to provide any comments to help explain your answers?

Initiative

Does Not
Exhibit this
Competency
Seldom
Exhibits this
Competency
Sometimes
Exhibits this
Competency
Usually
Exhibits this
Competency
Always
Exhibits this
Competency
  1. Analyzes the needs of the situation and acts before being told to do so.
  1. Addresses small problems before they become big ones.
  1. Seeks and utilizes opportunities for continuous learning and self-development.
  1. Initiates draft reports for consideration.
  1. Is proactive when preparing for potential problems or critical events.
Please feel free to provide any comments to help explain your answers?

Responsible

Does Not
Exhibit this
Competency
Seldom
Exhibits this
Competency
Sometimes
Exhibits this
Competency
Usually
Exhibits this
Competency
Always
Exhibits this
Competency
  1. Sets a good example.
  1. Holds herself / himself accountable to goals / objectives
  1. Sets a good example
  1. ...takes personal responsibility for results.
  1. Works in a way that makes others want to work with her/him.
Please feel free to provide any comments to help explain your answers?

Conflict Management

Does Not
Exhibit this
Competency
Seldom
Exhibits this
Competency
Sometimes
Exhibits this
Competency
Usually
Exhibits this
Competency
Always
Exhibits this
Competency
  1. Combines ideas and viewpoints of different team members.
  1. Sees conflicts as chances to develop innovative and effective solutions.
  1. Achieves mutually acceptable solutions through collaborative efforts by both parties.
  1. Acknowledges each party's intrinsic needs.
  1. Seeks to have both sides voluntarily work together to resolve their differences.
Please feel free to provide any comments to help explain your answers?

Entrepreneurship

Does Not
Exhibit this
Competency
Seldom
Exhibits this
Competency
Sometimes
Exhibits this
Competency
Usually
Exhibits this
Competency
Always
Exhibits this
Competency
  1. Excellent at managing relationships with stakeholders.
  1. Exhibits determination and passion in completion of goals.
  1. Understands the processes and various stages of business development.
  1. Encourages dynamic growth opportunities.
  1. Encourages risk taking for developing potential business opportunities.
Please feel free to provide any comments to help explain your answers?

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






  2. Strengths


  3. Areas for Development


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