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Action - 360 Degree Feedback Survey Sample #3





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)
Self-Assessment Instructions

Leadership at [Company] are participating in a 360-Degree Feedback assessment. As part of this process, you need to complete a self-assessment questionnaire form. Other employees, including your manager(s), peers, and direct reports will also evaluate you. In this manner, you will be provided with a comprehensive, multi-perspective (i.e., 360-degree) view of your performance as a manager. The objective is to provide you with feedback so as to allow you to improve your performance, resulting in improved team performance, and organizational effectiveness.

If you are not able to respond to an item, leave it blank and go on to the next item.

Competencies Included:
Action, Establishing Focus/Direction, Supervisory Skills, Initiative, Managing Risk, Regulatory/Compliance, Co-worker Development, Others, Organizational Fluency
Sample Result Document:
Sample Results
We encourage everyone to complete the survey. Please be honest, constructive and thoughtful in your input. The survey is designed to help us understand more about your thoughts and needs to make this a great company.

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



Edit this Survey
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Action

Does Not
Exhibit this
Competency
Seldom
Exhibits this
Competency
Sometimes
Exhibits this
Competency
Usually
Exhibits this
Competency
Always
Exhibits this
Competency
  1. I take steps to prepare for the start of the project.
  1. I gladly accept new challenges and work on them with urgency.
  1. I take the initiative to address problems sooner rather than later.
  1. I take responsibility for actions.
  1. I complete tasks on time in spite of delays in the process.
Please feel free to provide any comments to help explain your answers?

Establishing Focus/Direction

Does Not
Exhibit this
Competency
Seldom
Exhibits this
Competency
Sometimes
Exhibits this
Competency
Usually
Exhibits this
Competency
Always
Exhibits this
Competency
  1. I set deadlines and key milestones to guide the team's progress.
  1. You ensure that the department's plans support the broader vision and strategic goals of the organization.
  1. I am effective in giving direction to the department.
  1. You clarify priorities and expectations to ensure team members understand their roles and objectives.
  1. I build schedules that reflect both urgency and long-term strategic goals.
Please feel free to provide any comments to help explain your answers?

Supervisory Skills

Does Not
Exhibit this
Competency
Seldom
Exhibits this
Competency
Sometimes
Exhibits this
Competency
Usually
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Competency
Always
Exhibits this
Competency
  1. I am sought after for advice in a variety of situations.
  1. I am successful in resolving personnel conflicts.
  1. You use persuasion rather than threats of disciplinary action.
  1. I assign tasks appropriately.
  1. I seek to enhance the performance of employees under my supervision.
Please feel free to provide any comments to help explain your answers?

Initiative

Does Not
Exhibit this
Competency
Seldom
Exhibits this
Competency
Sometimes
Exhibits this
Competency
Usually
Exhibits this
Competency
Always
Exhibits this
Competency
  1. I look for opportunities to move projects forward.
  1. You are a self-starter. You do not wait to be told to do something.
  1. You confront problems immediately without supervisor instructions.
  1. You anticipate what needs to be done and makes necessary preparations.
  1. I took the initiative to develop contingency plans for high-risk scenarios before they materialize.
Please feel free to provide any comments to help explain your answers?

Managing Risk

Does Not
Exhibit this
Competency
Seldom
Exhibits this
Competency
Sometimes
Exhibits this
Competency
Usually
Exhibits this
Competency
Always
Exhibits this
Competency
  1. You accurately perceive potential risks in the workplace and initiates preventative measures.
  1. I accept risks as needed.
  1. I seek specific risks that will create opportunities to advance the department/company.
  1. I determine the impact of specific risks on infrastructure.
  1. You are aware of process safety management.
Please feel free to provide any comments to help explain your answers?

Regulatory/Compliance

Does Not
Exhibit this
Competency
Seldom
Exhibits this
Competency
Sometimes
Exhibits this
Competency
Usually
Exhibits this
Competency
Always
Exhibits this
Competency
  1. You understand the applicable regulations and laws that impact our business.
  1. I coordinate with legal counsel in conducting audits of legal compliance.
  1. I ensure appropriate followup for regulatory violations.
  1. I perform annual/monthly compliance audits.
  1. I periodically assess the effectiveness of regulatory/compliance programs.
Please feel free to provide any comments to help explain your answers?

Co-worker Development

Does Not
Exhibit this
Competency
Seldom
Exhibits this
Competency
Sometimes
Exhibits this
Competency
Usually
Exhibits this
Competency
Always
Exhibits this
Competency
  1. You adapt coaching and mentoring approach to meet the style or needs of individuals
  1. You work to identify root causes of performance problems
  1. You provide ongoing feedback to co-workers on your development progress
  1. You give others development opportunities through project assignments and increased job responsibilities
  1. You set and clearly communicate expectations, performance goals, and measurements to others
Please feel free to provide any comments to help explain your answers?

Others

Does Not
Exhibit this
Competency
Seldom
Exhibits this
Competency
Sometimes
Exhibits this
Competency
Usually
Exhibits this
Competency
Always
Exhibits this
Competency
  1. You work across boundaries within the organization.
  1. You treat others with respect and dignity.
  1. You are able to see issues from others' perspectives.
  1. You constructively receive criticism and suggestions from others.
  1. You respect the opinions of other employees.
Please feel free to provide any comments to help explain your answers?

Organizational Fluency

Does Not
Exhibit this
Competency
Seldom
Exhibits this
Competency
Sometimes
Exhibits this
Competency
Usually
Exhibits this
Competency
Always
Exhibits this
Competency
  1. You are able to explain departmental policies and procedures to others.
  1. You get things done through the department.
  1. You are able to deal with sensitive issues with tact and professionalism.
  1. You understand the current organizational culture.
  1. You are aware of other organizational cultures to compare/contrast with the current organizational culture.
Please feel free to provide any comments to help explain your answers?

  1. Overall, please rate the effectiveness of [Participant Name].






  2. Strengths


  3. Areas for Development


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