Vision- 360 Degree Feedback Survey Sample #8

Questionnaires Measuring Vision:
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. Creates a common vision for others.
  1. Demonstrates consistency between words and actions
  1. Clearly articulates a vision for his/her work and inspires others to support it
  1. Leads employees in new directions.
  1. Understands the vision of the Company and promotes it ahead of any self-interests.


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. Develops insights and applies innovative solutions to projects and problems.
  1. Flexible and open to new ideas and encourages others to value change.
  1. Recognizes and implements changes to enhance efficiency and effectiveness.
  1. Willing to change ideas or perceptions based on new information or contrary evidence which is presented.

Bias for Action

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. Motivates others to achieve or exceed goals
  1. Projects a "can-do" attitude when interfacing with peers, subordinates and customers(especially during difficult and challenging times).
  1. Encourages risk taking and experimentation to improve performance


Agree Unsure Disagree N/A
  1. Starts the workday when scheduled.
  1. Maintains an efficient schedule of activities.
  1. Invoices clients on a timely basis.
  1. Avoids making personal phone calls during working hours.
  1. Responds to requests for information in a timely manner.


Agree Unsure Disagree N/A
  1. Seeks and utilizes opportunities for continuous learning and self-development.
  1. Goes above and beyond the stated goals.
  1. Prepares for unexpected contingencies.
  1. Takes the initiative to change the direction or course of events.
  1. Coach others to foster an environment which can adapt quickly and willingly to rapid change.

Change Management

Agree Unsure Disagree N/A
  1. Effective in dealing with ambiguous and challenging situations.
  1. Addresses organizational and departmental resistance to changes.
  1. Adopts changes to set and example for others to follow.
  1. Works cooperatively with others to implement changes.
  1. Supports new initiatives for organizational changes to improve effectiveness.

Commitment To Result

Agree Unsure Disagree N/A
  1. Takes immediate action toward goals.
  1. Coordinates all department activities into a cohesive team effort.
  1. Committed to the team.
  1. Conveys strong sense of own pride in Company to associates by creating a shared vision around sales and customer service.
  1. Willing to do whatever it takes-not afraid to have to put in extra effort.

Managing Risk

Agree Unsure Disagree N/A
  1. Creates a risk management strategy for the department.
  1. Knows how to obtain desired results with minimal losses.
  1. Effectively responds to critical situations to reduce potential for losses.
  1. Seeks to maintain the long-term viability of the Company.
  1. Able to adapt quickly to changing situations.

Business Acumen

Agree Unsure Disagree N/A
  1. Applies the knowledge of work processes to influence the achievement of business goals
  1. Understands complex issues and problems.
  1. Effectively develops and uses resources (people, time, money, supplies, equipment, and space) to improve organizational performance
  1. Exhibits behavior that is consistent with the vision, mission, and core values of the organization
  1. Considers impact of actions on other areas of the organization.


Agree Unsure Disagree N/A
  1. Works in an organized manner
  1. Anticipates obstacles and ways to overcome them.
  1. Able to look ahead (beyond the present) when addressing the work/needs of the department.
  1. Makes plans and follows through.
  1. Able to identify the needs of the department before a major change.

  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.