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Feedback - 360 Degree Feedback Survey Sample #3





Questionnaires Measuring Feedback:
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 asked to evaluate yourself as part of a 360-degree feedback process. 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:
Feedback, Attitude, Cultural Awareness, Project Management, Decision Making, Commitment, Professional Development, Technical, Trustworthy, Co-worker Development, Vision
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.



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Feedback

Does Not
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Competency
Seldom
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  1. Leads constructive feedback sessions by emphasizing actual observations compared to performance goals.
  1. Improves employees on an ongoing basis through constructive feedback.
  1. Demonstrates urgency in addressing behavioral or performance gaps before they escalate.
  1. Supports employee development by providing targeted training and resources.
  1. Proactively seeks input from diverse sources to ensure all perspectives are acknowledged and different viewpoints are taken into account.
Please feel free to provide any comments to help explain your answers?

Attitude

Does Not
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  1. Embraces unexpected challenges with a calm, solution-oriented mindset.
  1. Responds constructively to last-minute changes and shifting priorities, without frustration or resistance, and with a positive attitude.
  1. Greets teammates each morning with authentic warmth and curiosity, setting a tone of shared purpose.
  1. Creates space for constructive dialogue around mistakes, viewing them as learning opportunities.
  1. Treats others with respect.
Please feel free to provide any comments to help explain your answers?

Cultural Awareness

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  1. Fosters a diverse workforce free from discrimination and harassment.
  1. Builds collaborative relationships by honoring cultural norms and interpersonal boundaries.
  1. Willing to work with employees who have different cultural backgrounds.
  1. Is responsive to individuals from other cultures.
  1. Actively listens to other employees' stories about their culture.
Please feel free to provide any comments to help explain your answers?

Project Management

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  1. Accurately determines the number of staff needed for the project.
  1. Determines the correct order for the phases of the project.
  1. Anticipates potential problems and institutes controls and contingency plans to address them.
  1. Understands the financial, strategic, resources, staffing, timeline and market risks that may impact the project.
  1. Determines the appropriate strategy for mitigating specific risks.
Please feel free to provide any comments to help explain your answers?

Decision Making

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  1. Frames decisions in compelling narratives that inspire buy-in and clarify vision.
  1. Outlines the parameters influencing the decision making process.
  1. Approaches challenges from unconventional angles, revealing new paths forward.
  1. Decision making involves careful analysis of the facts and consideration of parameters and constraints.
  1. Makes decisions that support the department's goals and objectives.
Please feel free to provide any comments to help explain your answers?

Commitment

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  1. Champions collective wins, inspiring pride in shared accomplishments that deepen commitment to future endeavors.
  1. Committed to the company.
  1. Provides developmental opportunities to strengthen employee commitment to the organization.
  1. Encourages employees to channel their abilities toward achieving organizational outcomes.
  1. Anticipates potential distractions and proactively minimizes them to protect commitment to results.
Please feel free to provide any comments to help explain your answers?

Professional Development

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  1. Encourages employees to take courses relevant to their job.
  1. Seeks opportunities for continuous learning.
  1. Keep themselves up-to-date of technical/professional issues
  1. Quickly acquire and apply new knowledge and skills when needed
  1. Demonstrate enthusiasm and a willingness to learn new skills and knowledge
Please feel free to provide any comments to help explain your answers?

Technical

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  1. Is knowledgeable of procedures or systems necessary for the job.
  1. Uses expertise to identify issues and think through creative solutions to get a problem solved or objective accomplished.
  1. Willingly shares his/her technical expertise; sought out as resource by others
  1. Willingly shares information and expertise; sought out as resource by others
  1. Keeps current with technical advances within his/her professional discipline; embraces and applies new techniques and practices
Please feel free to provide any comments to help explain your answers?

Trustworthy

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  1. Consistently keeps commitments.
  1. Delivers on promises made.
  1. Demonstrates congruence between statements and actions.
  1. Builds and maintains the trust of others.
  1. Seeks to mitigate grievances by clarifying intentions and finding suitable remedies.
Please feel free to provide any comments to help explain your answers?

Co-worker Development

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  1. Gives others development opportunities through project assignments and increased job responsibilities
  1. Works to identify root causes of performance problems
  1. Takes immediate action on poor performance
  1. Provides ongoing feedback to co-workers on their development progress
  1. Sets and clearly communicates expectations, performance goals, and measurements to others
Please feel free to provide any comments to help explain your answers?

Vision

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  1. Regularly revisits and re-articulates the vision in team meetings, updates, and one-on-ones.
  1. Provides the vision needed to help the organization remain competitive and adaptable in a dynamic market.
  1. Builds momentum by celebrating small wins that reflect progress toward the vision.
  1. Persuasively links departmental goals to broader organizational impact, fostering buy-in across levels.
  1. Provides vision and strategies to the team.
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.