Vision- 360 Degree Feedback Survey Sample #11

360 Feedback Survey

Assessments 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)

Thank you for providing feedback for the recipient above. As you respond, please draw on your first-hand experience with this individual in the past 12 months. Rate each item using the scale shown. If you don't feel you have enough first-hand information to rate a certain item, please choose the Not Applicable option. Comments can be very helpful; at a minimum where you give a particularly high or low rating, please share your reasons in the comment section for that competency. Your responses will be compiled with feedback from others and presented to the recipient to help guide their ongoing development.

Partially completed forms can be saved by using the Save/Still Working button at the bottom of the page. You may return at a later time to complete/edit the form. Your saved responses will be shown each time you re-visit the feedback form. When you are certain that you have completed your responses and will be not making any changes, click the Complete button.

To what extent does [Participant Name] exhibit the following ...

SELECT the rating that best reflects the employee's performance in the areas listed.


What does Vision mean?
It means that ...
  • You work to support the strategy of [Company]
  • You behave in a way that is consistent with business values & code of conduct
  • You persuade others to follow the Company's vision.
  • You communicate a vision of where the Company needs to be in the future.
  • You express the Company vision in a way that is easily understood and adopted by employees.

To what extent does this person exhibit Vision?
Select from one of the ratings below.

Cultural Awareness

What does Cultural Awareness mean?
It means that ...
  • I am aware of differences in how individuals from other cultures greet one another.
  • I interact effectively with people from different cultural backgrounds.
  • I am willing to include individuals with different cultural backgrounds on the team.
  • I view diversity as a strength, not as an issue.
  • I am responsive to individuals from other cultures.

To what extent does this person exhibit Cultural Awareness?
Select from one of the ratings below.


What does Delegation mean?
It means that ...
  • You tell subordinates what to do, not how to do it.
  • You allow employees to decide how they wish to complete the tasks.
  • You delegate tasks, responsibilities, and accountability as appropriate to the level of employee.
  • You assign tasks to create learning opportunities for the employees.
  • You clearly define duties and tasks to be completed.

To what extent does this person exhibit Delegation?
Select from one of the ratings below.


What does Partnering/Networking mean?
It means that ...
  • You forge mutually beneficial relationships between individuals with diverse backgrounds.
  • You seek an understanding of diverse functions within the Company.
  • You support and encourage relationships that are created by diverse team members.
  • You maintain infrastructure to support partnerships and networks.
  • You partner with peers to obtain influence within the Company.

To what extent does this person exhibit Partnering/Networking?
Select from one of the ratings below.


What does Adaptability mean?
It means that ...
  • You perform a wide range of tasks, respond to changes in direction and priorities and accept new challenges, responsibilities, and assignments.
  • You are flexible when dealing with changes.
  • You are aware of changes to team personnel.
  • You work effectively with various personalities of team members.
  • You are proactive and takes steps to prepare for changes in the workplace.

To what extent does this person exhibit Adaptability?
Select from one of the ratings below.

Areas for Development

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