Feedback Competency Questionnaire 5
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HR-Survey > 360-Degree Feedback > Competency Model > Feedback Skills
Feedback - 360 Degree Feedback Survey Sample #5
360-Degree Assessment Survey November 2025
Dear Employee:
Questionnaires Measuring Feedback:
Thank you for providing feedback for the recipient above. As you Survey 1 (4-point scale; Competency Comments)
respond, please draw on your first-hand experience with this Survey 2 (4-point scale; Competency Comments)
individual in the past 12 months. Rate each item using the scale Survey 3 (5-point scale; Competency Comments)
shown. If you don't feel you have enough first-hand information to Survey 4 (5-point scale; radio buttons)
rate a certain item, please choose the Not Applicable option. Survey 5 (4-point scale; words)
Comments can be very helpful; at a minimum where you give a Survey 6 (4-point scale; words)
particularly high or low rating, please share your reasons in the Survey 7 (5-point scale; competency comments; N/A)
Closing Comments section. Your responses will be compiled with Survey 8 (3-point scale; Agree/Disagree words; N/A)
feedback from others and presented to the recipient to help guide Survey 9 (3-point scale; Strength/Development; N/A)
their ongoing development. Survey 10 (Comment boxes only)
Survey 11 (Single rating per competency)
Survey 12 (Slide-bar scale)
Competencies Included: Survey 13 (4-point scale; numbers; floating anchors)
Feedback, Attitude, Trustworthy, Customer Focus, Survey 14 (4-point scale; N/A)
Strategic Insight, Vision
Partially completed forms can be saved by using the Save/Still
Working button at the bottom of the page. You may return at a Sample Result Document:
later time to complete/edit the form. Your saved responses will be Sample Results
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 by November 16.
Thank you for your participation in the survey.
Management Team
Role Capable and Somewhat Needs
Feedback Model Effective Effective Development
1. Hosts training sessions on communication skills,
Role Capable and Somewhat Needs
supplying self-assessment tools, and setting up
Model Effective Effective Development
feedback systems.
Role Capable and Somewhat Needs
2. Regards feedback as a beneficial opportunity.
Model Effective Effective Development
3. Considers feedback as a positive and enriching Role Capable and Somewhat Needs
process. Model Effective Effective Development
Role Capable and Somewhat Needs
4. Invites and values input from others to gain a more
Model Effective Effective Development
comprehensive understanding of their abilities and
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areas where they can develop further.
5. Promotes an atmosphere that champions Role Capable and Somewhat Needs
continuous education and enhancement. Model Effective Effective Development
Role Capable and Somewhat Needs
Attitude Model Effective Effective Development
Role Capable and Somewhat Needs
6. Has a concern for employees in the department.
Model Effective Effective Development
Role Capable and Somewhat Needs
7. Approaches setbacks with a positive attitude.
Model Effective Effective Development
Role Capable and Somewhat Needs
8. Is willing to mentor and coach employees.
Model Effective Effective Development
9. Enjoys discussing progress, especially in team Role Capable and Somewhat Needs
meetings or performance reviews. Model Effective Effective Development
Role Capable and Somewhat Needs
10. Always does their best effort on the job.
Model Effective Effective Development
Role Capable and Somewhat Needs
Trustworthy Model Effective Effective Development
11. Demonstrates congruence between statements and Role Capable and Somewhat Needs
actions. Model Effective Effective Development
Role Capable and Somewhat Needs
12. Is a person you can trust.
Model Effective Effective Development
Role Capable and Somewhat Needs
13. Consistently keeps commitments.
Model Effective Effective Development
14. Seeks to mitigate grievances by clarifying intentions Role Capable and Somewhat Needs
and finding suitable remedies. Model Effective Effective Development
15. Communicates an understanding of the other Role Capable and Somewhat Needs
person's interests, needs and concerns. Model Effective Effective Development
Role Capable and Somewhat Needs
Customer Focus Model Effective Effective Development
16. Makes sure customer needs are understood by the Role Capable and Somewhat Needs
team members. Model Effective Effective Development
Role Capable and Somewhat Needs
17. Is committed to the success of the customer.
Model Effective Effective Development
Role Capable and Somewhat Needs
18. Meets with customers on a regular basis.
Model Effective Effective Development
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Role Capable and Somewhat Needs
19. Thoroughly understands the needs of the customer.
Model Effective Effective Development
Role Capable and Somewhat Needs
20. Acts with integrity in all customer interactions.
Model Effective Effective Development
Role Capable and Somewhat Needs
Strategic Insight Model Effective Effective Development
21. Strategically aligns projects to the goals of the Role Capable and Somewhat Needs
company. Model Effective Effective Development
22. Ensures that the department's goals are strategically Role Capable and Somewhat Needs
aligned with the company's goals. Model Effective Effective Development
23. Integrates financial, operational, and market data to Role Capable and Somewhat Needs
guide strategic priorities and resource allocation. Model Effective Effective Development
24. Creates strategic plans to develop and promote
Role Capable and Somewhat Needs
organizational and area strengths, as well as to
Model Effective Effective Development
address weaknesses based on insight from surveys.
25. Adjusts strategic plans based on insights gathered Role Capable and Somewhat Needs
from different points of view. Model Effective Effective Development
Role Capable and Somewhat Needs
Vision Model Effective Effective Development
26. Creates a vision to align corporate strategies with Role Capable and Somewhat Needs
the organization's value system. Model Effective Effective Development
27. Enables employees to commit to the departmental Role Capable and Somewhat Needs
vision. Model Effective Effective Development
28. Channels team activities towards the vision's core Role Capable and Somewhat Needs
aspects. Model Effective Effective Development
29. Provides the vision needed to help the organization
Role Capable and Somewhat Needs
remain competitive and adaptable in a dynamic
Model Effective Effective Development
market.
30. Aligns subordinates' work with the vision's critical Role Capable and Somewhat Needs
priorities. Model Effective Effective Development
31. Overall, please rate the effectiveness of [Participant Name Here].
5- Very Effective
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4- Effective
3- Neither
2- Ineffective
1- Very Ineffective
32. Strengths
33. Areas for Development
34. Please give any final comments or suggestions for [Participant Name Here]'s assessment.
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