360 Feedback Survey Sample Questionnaire 71

This example questionnaire shows how comments can be an integral part of the survey. In this example, a comment box is provided for each rating made by the participant. These written comments provide valuable feedback in more detail than just a single rating.

ABC Global 360-Degree Feedback


You are providing feedback to:


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 twelve months. Your responses will be merged with other's feedback and presented to the manager to guide them in their on-going development. Comments will be shared anonymously as written with the manager, unless you indicate otherwise.

Method of use: As part of the annual appraisal process, leaders receive feedback from peers, subordinates, customers and supervisors. 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 individual's annual appraisal and development plan.

Your questionnaire can be customized to include competencies and items relevant for your needs. Competencies and items can vary depending on job classification or other demographic factors.

To what extent does ____________ exhibit the following ...

Performance Rating Guide:

Excels/Role model. Results consistently exceed expectations. Makes significant contributions well beyond requirements. Outpaces the majority of peers.

Fully Proficient. Results are fully and consistently on target. Makes a valuable contribution. Is fully competent. This level describes performance of the majority of employees.

Developing/Usually meets standards. Results are usually on target. May need occasional support. Still learning how to perform responsibilities independently.

Needs improvement. Improvement clearly needed. Is consistent in performance and requires excessive supervision and support. An action plan for improvement in this area needed.

    High Quality Standards
    • Requires superior quality performance.
    • Strives to produce the highest quality work products.
    • Encourages others to achieve high quality standards.
    • Corrects issues in a timely manner.

    Goals and Objectives
    • Sets short and long term goals for self without being pushed.
    • Achieves established goals.
    • Measures and evaluates performance as related to business/customer needs.
    • Makes sure that team members have a clear idea of our group's goals.

    Results Oriented
    • Explains the positive impact of maintaining a high energy level to drive branch performance
    • Stays focused on solving problems and getting work done.
    • Exhibits high energy and a positive attitude on the job with co-workers and customers
    • Holds employees accountable for completing required work.

    Management Skills
    • Sets an example for others to follow
    • Manages staff and prepares work schedules appropriately
    • Motivates others to reach and exceed their goals and objectives.
    • Influences the department and organizational decisions made.

    • Adapts to circumstances as needed.
    • Open to the perspectives/viewpoints of others.
    • Learns from personal experiences and/or mistakes.
    • Encourages others to adopt new procedures.

    Bias for Action
    • Works quickly when faced with difficult problems.
    • Works across organizational lines and boundaries to attain goals.
    • Motivates others to achieve or exceed goals.
    • Seeks and utilizes opportunities for continuous learning and self-development.
    • Prepares for potential problems and opportunities in working toward desired goals.

    Client Focus
    • Focuses the department on meeting requirements of clients.
    • Helps clients to feel satisfied with our work/services.
    • Anticipates problems that the client may encounter.
    • Establishes good raport with clients.

    • Develops the skills and capabilities of others.
    • Conducts regular performance appraisals and feedback.
    • Helps employees to find and correct their own errors.
    • Creates plans for achieving results that are specific, measurable and have target dates.

    Open-Ended Comments

    Note: When you enter text comments into the boxes below, please focus your comments on work behaviors and styles. The comments that you type will be viewed by the individual receiving the feedback. Do not enter personal information about yourself unless you want this individual to know you are the author of these comments.

    Comments with regard to overall performance in their current job responsibilities.
    Comments with regard to commitment to customer service and excellence.

    Styles or behaviors that make you an effective leader.

    Your areas for focus and development

    Status of the Form

    Upon clicking this button any responses will be saved. You can still return to the form to enter/review responses.