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Action - 360 Degree Feedback Survey Sample #2





Questionnaires Measuring Action:
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)
Survey 13 (4-point scale; numbers; floating anchors)
Survey 14 (4-point scale; N/A)
Instructions

You have been selected to provide feedback on the employee listed above. Your feedback is an important part of our company's leadership development process and this survey 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 questions below, think about your experiences working with this employee over the last twelve months and the goals they were asked to achieve. The effectiveness of this development tool is dependent on your honest, forthright and constructive responses so please bear this in mind as you answer each question. Your responses will be discussed with the employee to foster growth and on-going development.

Competencies Included:
Action, Punctuality, Attitude, Management, Commitment, Technical, Trustworthy, Conflict Management, Teamwork, Vision
Sample Result Document:
Sample Results
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.

Please ensure that your submission is made between . The survey will only be available during these dates.
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Action

Clear
Strength
Capable
and
Effective
Could
Benefit from
Development
Needs
Significant
Improvement
  1. Does not procrastinate when there is a job to be done.
  1. Able to get things done and make things happen.
  1. Acts immediately instead of waiting for someone else to solve the issue.
  1. Seeks new opportunities for advancement.
  1. Drives and mobilizes others progress toward goals.
What are your suggestions for how [Participant Name] can make improvements
in Action?

Punctuality

Clear
Strength
Capable
and
Effective
Could
Benefit from
Development
Needs
Significant
Improvement
  1. Invoices clients on a timely basis.
  1. Starts meetings on time.
  1. Maintains an efficient schedule of activities.
  1. Avoids making personal phone calls during working hours.
  1. Starts the workday when scheduled.
What are your suggestions for how [Participant Name] can make improvements
in Punctuality?

Attitude

Clear
Strength
Capable
and
Effective
Could
Benefit from
Development
Needs
Significant
Improvement
  1. Has a concern for employees in the department.
  1. Displays persistence in pursuing goals despite obstacles and setbacks.
  1. Faces setbacks with composure and reframes challenges as opportunities for growth.
  1. Volunteers to take responsibility for assignments that fall outside their immediate scope to help move the team forward.
  1. Acknowledges team members' emotions and perspectives, even when they differ from their own.
What are your suggestions for how [Participant Name] can make improvements
in Attitude?

Management

Clear
Strength
Capable
and
Effective
Could
Benefit from
Development
Needs
Significant
Improvement
  1. Embodies a values-driven approach to work that energizes and galvanizes the team.
  1. Defines the roles, responsibilities, required actions, and deadlines for team members.
  1. Effectively allocates resources and schedules tasks to support successful execution of assigned projects.
  1. This manager makes you feel enthusiastic about your work.
  1. Tracks progress against strategic goals and uses insights to refine future plans.
What are your suggestions for how [Participant Name] can make improvements
in Management?

Commitment

Clear
Strength
Capable
and
Effective
Could
Benefit from
Development
Needs
Significant
Improvement
  1. Fosters a culture of trust to build high employee commitment and lower turnover.
  1. Demonstrates authentic passion, sparking loyalty and motivating employees to align their work with organizational priorities.
  1. Rallies diverse perspectives, inspiring unity by showing how differences strengthen the team's commitment.
  1. Persistent and dedicated to obtaining results.
  1. Maintains concentration on critical outcomes, even when faced with competing demands or shifting circumstances.
What are your suggestions for how [Participant Name] can make improvements
in Commitment?

Technical

Clear
Strength
Capable
and
Effective
Could
Benefit from
Development
Needs
Significant
Improvement
  1. Demonstrates mastery of the technical competencies required in his/her work.
  1. Is knowledgeable of procedures or systems necessary for the job.
  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. Knows how to produce high quality products/work.
  1. Willingly shares his/her technical expertise; sought out as resource by others
What are your suggestions for how [Participant Name] can make improvements
in Technical?

Trustworthy

Clear
Strength
Capable
and
Effective
Could
Benefit from
Development
Needs
Significant
Improvement
  1. Takes care to maintain confidential information.
  1. Works in a way that makes others want to work with her/him.
  1. Consistently keeps commitments.
  1. Delivers on promises made.
  1. Demonstrates congruence between statements and actions.
What are your suggestions for how [Participant Name] can make improvements
in Trustworthy?

Conflict Management

Clear
Strength
Capable
and
Effective
Could
Benefit from
Development
Needs
Significant
Improvement
  1. Resolves grievances through a better understanding and appreciation of what each side needs.
  1. Builds coalitions or allies to reinforce key messages and create momentum for resolution.
  1. Seeks to reduce the scarcity of limited resources by sourcing materials from new locations.
  1. Ensures that all team members feel respected and heard.
  1. Able to persuade and influence others.
What are your suggestions for how [Participant Name] can make improvements
in Conflict Management?

Teamwork

Clear
Strength
Capable
and
Effective
Could
Benefit from
Development
Needs
Significant
Improvement
  1. Helps the team exercise good judgment by making sound and informed decisions.
  1. Encourages other team members to adopt new procedures.
  1. Shares pertinent information with all members of the team.
  1. Works well with other team members.
  1. Demonstrates an understanding of other team member's viewpoints.
What are your suggestions for how [Participant Name] can make improvements
in Teamwork?

Vision

Clear
Strength
Capable
and
Effective
Could
Benefit from
Development
Needs
Significant
Improvement
  1. Envisions and articulates a clear path for the department's growth over the next year.
  1. Is skilled at recognizing various issues that arise and formulates practical and strategic solutions to resolve them efficiently.
  1. Delegates the task of implementing the vision to subordinates.
  1. Defines an ideal image for what the department should look like in the future.
  1. Shares personal reflections or experiences that illustrate commitment to the vision.
What are your suggestions for how [Participant Name] can make improvements
in Vision?


  1. Strengths


  2. Areas for Development


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