Trustworthy - 360 Degree Feedback Survey Sample #3





Questionnaires Measuring Trustworthiness:
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)
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.

Competencies Included:
Trustworthy, Interpersonal Skills, Adaptability, Creativity, Passion To Learn, Continual Learning, Quality, Initiative, Responsible, Conflict Management, Entrepreneurship
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
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Competency
Sometimes
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Competency
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Competency
  1. Is a person you can trust.
  1. Demonstrates a sense of responsibility and commitment to public trust.
  1. Seeks to mitigate grievances by clarifying intentions and finding suitable remedies.
  1. Is trustworthy; is someone I can trust.
  1. Takes ownership, delivers on commitments
Please feel free to provide any comments to help explain your answers?

Interpersonal Skills

Does Not
Exhibit this
Competency
Seldom
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Competency
Sometimes
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Competency
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Competency
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Competency
  1. Uses knowledge and charisma rather than position, power, or coercion to influence others
  1. Maintains a high degree of honesty and integrity.
  1. Is a committed and reliable partner.
  1. Respectful of the opinions and ideas of others.
  1. Attends to both the content and the context of what was being said.
Please feel free to provide any comments to help explain your answers?

Adaptability

Does Not
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Competency
Seldom
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Competency
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Competency
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  1. Adjusts plans to meet the needs of new constraints.
  1. Able to work effectively with new people and new teams.
  1. Is open to changes in policies and procedures.
  1. Performs a wide range of tasks, responds to changes in direction and priorities and accepts new challenges, responsibilities, and assignments.
  1. Is flexible and open minded in dealing with others.
Please feel free to provide any comments to help explain your answers?

Creativity

Does Not
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Competency
Seldom
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Competency
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Competency
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  1. Creates a lot of new ideas.
  1. Inspires creativity in their team.
  1. Is creative and inspirational.
  1. Conceives, implements and evaluates ideas.
  1. Develops solutions to challenging problems.
Please feel free to provide any comments to help explain your answers?

Passion To Learn

Does Not
Exhibit this
Competency
Seldom
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Competency
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Competency
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Competency
  1. Demonstrates a willingness to participate in continuing education courses.
  1. Recognizes own areas for development and consciously seeks assignments that will provide practice in areas of developmental need.
  1. Demonstrates through personal behavior the commitment to high standards of performance.
  1. Takes advantage of training opportunities when they arise.
  1. Embraces new technology and procedures.
Please feel free to provide any comments to help explain your answers?

Continual Learning

Does Not
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Competency
Seldom
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Competency
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Competency
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Competency
  1. Pursues professional development opportunities when they arise.
  1. Pursues self-improvement through continual learning.
  1. Seeks opportunities to grow in skills and knowledge.
  1. Improves on their skill sets.
  1. Pursues learning that will enhance job performance.
Please feel free to provide any comments to help explain your answers?

Quality

Does Not
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Competency
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Competency
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  1. Addresses barriers to successfully implementing quality standards.
  1. Identifies strategies and their associated risks to improve quality.
  1. Develops processes to enhance quality standards.
  1. Successfully implements quality controls within the department.
  1. Positively influences others to strive to attain high quality standards.
Please feel free to provide any comments to help explain your answers?

Initiative

Does Not
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Competency
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Competency
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Competency
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  1. Updates the documentation as soon as the situation changes.
  1. Initiates actions that impact the department/company.
  1. Independently seeks out new learning opportunities to improve their skills.
  1. Analyzes the needs of the situation and acts before being told to do so.
  1. Is an inspiration for others to perform above expectations.
Please feel free to provide any comments to help explain your answers?

Responsible

Does Not
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Competency
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  1. ...takes personal responsibility for results.
  1. Responsible for setting the vision of the department.
  1. Completes assigned work tasks.
  1. Works in a way that makes others want to work with her/him.
  1. Holds herself / himself accountable to goals / objectives
Please feel free to provide any comments to help explain your answers?

Conflict Management

Does Not
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Competency
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  1. Establishes roles and responsibilities.
  1. Addresses contentious issues earlier rather than later.
  1. Values the diverse perspectives of others.
  1. Discusses conflict situations with supervisor.
  1. Seeks to achieve mutually acceptable outcomes.
Please feel free to provide any comments to help explain your answers?

Entrepreneurship

Does Not
Exhibit this
Competency
Seldom
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Competency
Sometimes
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Competency
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Competency
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Exhibits this
Competency
  1. Able to adapt the department to changing business demands and climate.
  1. Balances risks and rewards when making decisions.
  1. Has a strategic awareness on how to promote the organization.
  1. Exhibits determination and passion in completion of goals.
  1. Can work effectively in an environment of uncertainty.
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.