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HR-Survey > 360-Degree Feedback > Competency Model > Passion to Learn

Self-Management - 360 Degree Feedback Survey Sample #13

November 2, 2025

Instructions
Questionnaires Measuring Self:
We are delighted to extend an invitation to you to provide valuable Survey 1 (4-point scale; Competency Comments)
feedback on the manager listed above. Your insights and Survey 2 (4-point scale; Competency Comments)
observations are a crucial element in our continuous efforts to Survey 3 (5-point scale; Competency Comments)
enhance our leadership development program. This feedback tool Survey 4 (5-point scale; radio buttons)
has been meticulously designed to gather detailed and Survey 5 (4-point scale; words)
comprehensive input on the core competencies and role Survey 6 (4-point scale; words)
responsibilities that are integral to the ongoing success and growth Survey 7 (5-point scale; competency comments; N/A)
of our organization. Survey 8 (3-point scale; Agree/Disagree words; N/A)
Survey 9 (3-point scale; Strength/Development; N/A)
We believe that your unique perspective, based on your interactions Survey 10 (Comment boxes only)
and experiences with this manager, will contribute significantly to Survey 11 (Single rating per competency)
identifying strengths, areas for improvement, and opportunities for Survey 12 (Slide-bar scale)
professional growth. Your feedback will help us foster a culture of Survey 13 (4-point scale; numbers; floating anchors)
excellence, accountability, and continuous improvement within our Survey 14 (4-point scale; N/A)
leadership team.

As you complete the assessment form, please reflect on your interactions with this individual over the past six to twelve months. Your
responses will be combined with feedback from others and presented to the manager to aid in their ongoing development. Rest
assured, your comments will be shared anonymously, exactly as you write them.

Method of use: As part of the review process, managers will receive

feedback from peers and staff. It is recognized that not all Sample Result Document:
participants will be able to assess an individual's performance in all Sample Results
areas. The feedback received will be utilized as input to the
manager's performance and on-going development plan.

You may sign out at any time by pressing the Save button at the end of the form and then closing your browser. You may return later
to pick up where you left off. When you are done, press the Complete button.

When clicking your selection below, try to best fit the manager's Competencies Included:
actual behaviors to the scale provided. Passion To Learn, Managing Performance, Performance,
Innovation, Technology Use/Management, Collaboration
If you are not sure, or unable to assess, select "Not Applicable"
(N/A) option.

Please complete your response by November 16.

Strongly Strongly
Passion To Learn Disagree Disagree Agree Agree

1. Demonstrates through personal behavior the

commitment to high standards of performance. 1 2 3 4

2. Takes advantage of training opportunities when they

arise. 1 2 3 4

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 3. Is open minded and curious about learning new
skills. 1 2 3 4

4. Takes initiative for own learning and development. 1 2 3 4

5. Embraces new technology and procedures. 1 2 3 4

6. Constantly enhances product knowledge through

experimentation and play. 1 2 3 4

7. Will participate in training classes even if offered

outside of normal working hours. 1 2 3 4

8. Recognizes own areas for development and

consciously seeks assignments that will provide 1 2 3 4
practice in areas of developmental need.

9. Holds self and associates accountable for goal

achievement. 1 2 3 4

Strongly Strongly
Managing Performance Disagree Disagree Agree Agree

10. Ensures that team goals are met 85 percent of the

time. 1 2 3 4

11. Provides employees with training as needed to

increase their performance. 1 2 3 4

12. Establishes indicators to measure levels of

performance. 1 2 3 4

13. Provides employees with necessary resources to

accomplish their goals. 1 2 3 4

14. Makes sure the team's goals are met. 1 2 3 4

Strongly Strongly
Performance Disagree Disagree Agree Agree

15. Able to organize work. 1 2 3 4

16. Sets a high standard for job performance. 1 2 3 4

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 17. Has great overall performance 1 2 3 4

18. Effective in performing his/her job. 1 2 3 4

19. Listens and responds to issues and problems 1 2 3 4

Strongly Strongly
Innovation Disagree Disagree Agree Agree

20. Coordinates the activities of the innovation steering

committee. 1 2 3 4

21. Willing to entertain and experiment with new ideas

leading to potential breakthrough innovations and 1 2 3 4
competitive advantages.

22. Solves problems with insight and understanding. 1 2 3 4

23. Transforms raw ideas into actionable plans with a

higher likelihood of successful implementation. 1 2 3 4

24. Seeks new ideas and adapts to changing

environments. 1 2 3 4

Strongly Strongly
Technology Use/Management Disagree Disagree Agree Agree

25. Uses technology in decision making and problem

solving. 1 2 3 4

26. Understands and is committed to implementing

new technologies. 1 2 3 4

27. Maximizes the use of new technology to deliver

products and services. 1 2 3 4

28. Proficient in the use of technical systems and

processes. 1 2 3 4

29. Supports technical training and development of

employees. 1 2 3 4

Strongly Strongly
Collaboration Disagree Disagree Agree Agree

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 30. Participates in collaborative/team decision-making. 1 2 3 4

31. Defines shared goals with the committee members. 1 2 3 4

32. Maintains strong relationships with suppliers to

ensure quality standards are met. 1 2 3 4

33. Effectively works with others to create solutions to

problems. 1 2 3 4

34. Integrates technology to boost collaborative work

on process and policy documentation. 1 2 3 4

35. Describe the greatest strengths of this person with regard to his/her overall effectiveness in performing
his/her current responsibilities.

36. Describe the most important things this person could improve upon in order to increase his/her overall
effectiveness in performing his/her current responsibilities.

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

5- Very Effective
4- Effective
3- Neither
2- Ineffective
1- Very Ineffective

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

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