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)
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 .


Agree Unsure Disagree N/A
  1. Is trustworthy; is someone I can trust.
  1. Consistently keeps commitments.
  1. Seeks to mitigate grievances by clarifying intentions and finding suitable remedies.
  1. Delivers on promises made.
  1. Is a person you can trust.


Agree Unsure Disagree N/A
  1. Is proactive and takes steps to prepare for changes in the workplace.
  1. Adjusts priorities to changing business goals.
  1. Performs a wide range of tasks, responds to changes in direction and priorities and accepts new challenges, responsibilities, and assignments.
  1. Flexible and open to new ideas and encourages others to value change.
  1. Ability to recognize the potential benefits of change, and create an infrastructure which supports change.


Agree Unsure Disagree N/A
  1. Demonstrates honesty and truthfulness at all times.
  1. Follows tasks to completion.
  1. Demonstrates sincerity in actions with others.
  1. Maintains strong relationships with others.
  1. Fosters an environment built upon trust.


Agree Unsure Disagree N/A
  1. Keep staff informed about what is happening in the company
  1. Takes responsibility for things that go wrong
  1. Delegate tasks effectively
  1. Sets an example for others to follow
  1. Is ready to offer help


Agree Unsure Disagree N/A
  1. Seeks and utilizes opportunities for continuous learning and self-development.
  1. Coach others to foster an environment which can adapt quickly and willingly to rapid change.
  1. Immediately works to complete goals well before their deadline.
  1. Takes action without being asked.
  1. Takes decisive action to address problems, following up with relevant team members and coaching them on how to improve.


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

Interpersonal Skills

Agree Unsure Disagree N/A
  1. Able to work with individuals at all levels of the Company.
  1. Successfully resolves conflicts and grievances to a win-win solution.
  1. Strives for win/win solutions
  1. Uses tact, compassion, and sensitivity in interactions with others.
  1. Is open and approachable


Agree Unsure Disagree N/A
  1. Sets a good example
  1. Sets a good example.
  1. Sets high personal standards of performance.
  1. Responsible for setting the vision of the department.
  1. Acts as a resource without removing individual responsibility.


Agree Unsure Disagree N/A
  1. Conducts regular performance appraisals and feedback.
  1. Addresses employee behavior problems effectively.
  1. Meets regularly with employees to coach them on areas that will enhance their performance
  1. Helps employees to understand responsibilities, authority, and expectations.
  1. Coaches employees in how to strengthen knowledge and skills to improve work performance.


Agree Unsure Disagree N/A
  1. Treats others with respect and dignity.
  1. ...treats others with respect and dignity.
  1. Consistently demonstrates ability and willingness to trust others.
  1. Helpful
  1. Forms working relationships with employees from other departments.

  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.