Trustworthy - 360 Degree Feedback Survey Sample #8

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)

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 .


Agree Unsure Disagree N/A
  1. Demonstrates congruence between statements and actions.
  1. Works in a way that makes others want to work with her/him.
  1. Is trustworthy; is someone I can trust.
  1. Demonstrates a sense of responsibility and commitment to public trust.
  1. Takes ownership, delivers on commitments


Agree Unsure Disagree N/A
  1. Performs a wide range of tasks, responds to changes in direction and priorities and accepts new challenges, responsibilities, and assignments.
  1. Learns from personal experiences and/or mistakes.
  1. Develops insights and applies innovative solutions to projects and problems.
  1. Is flexible and open minded in dealing with others.
  1. Works effectively in dynamic and changing work environments.


Agree Unsure Disagree N/A
  1. Fosters an environment built upon trust.
  1. Does what was promised.
  1. Accepts responsibility for mistakes.
  1. Fosters a high standard of ethics and integrity.
  1. Establishes relationships of trust, honesty, fairness, and integrity.


Agree Unsure Disagree N/A
  1. Sets an example for others to follow
  1. Is ready to offer help
  1. Takes responsibility for things that go wrong
  1. Keep staff informed about what is happening in the company
  1. Makes you feel enthusiastic about your work


Agree Unsure Disagree N/A
  1. Immediately works to complete goals well before their deadline.
  1. Seeks and utilizes opportunities for continuous learning and self-development.
  1. Takes the initiative to change the direction or course of events.
  1. Takes action without being asked.
  1. Prepares for unexpected contingencies.


Agree Unsure Disagree N/A
  1. Demonstrates mastery of the technical competencies required in his/her work.
  1. Willingly shares information and expertise; sought out as resource by others
  1. Knows how to produce high quality products/work.
  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.

Interpersonal Skills

Agree Unsure Disagree N/A
  1. Able to work with individuals at all levels of the Company.
  1. Comes across as credible, knowledgeable and sincere
  1. Is a role model for others
  1. Is open and approachable
  1. Demonstrates willingness to work with others.


Agree Unsure Disagree N/A
  1. Sets high personal standards of performance.
  1. Completes assigned work tasks.
  1. Behavior is ethical and honest.
  1. Holds herself / himself accountable to goals / objectives
  1. Works in a way that makes others want to work with her/him.


Agree Unsure Disagree N/A
  1. Meets regularly with employees to coach them on areas that will enhance their performance
  1. Coaches employees in how to strengthen knowledge and skills to improve work performance.
  1. Provides clear, motivating, and constructive feedback.
  1. Helps employees to maintain high personal standards.
  1. Addresses employee behavior problems effectively.


Agree Unsure Disagree N/A
  1. Helpful
  1. Respects the opinions of other employees.
  1. Works across boundaries within the organization.
  1. Supports the efforts of other employees in implementing solutions to problems.
  1. Able to see issues from others' perspectives.

  1. Overall, please rate the effectiveness of .

  2. Strengths

  3. Areas for Development

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