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Initiative - 360 Degree Feedback Survey Sample #6

360-Degree Assessment Survey November

Dear Employee:
Questionnaires Measuring Initiative:
You have been selected to participate in a 360-assessment. As part Survey 1 (4-point scale; Competency Comments)
of this process you will need to complete the self-assessment Survey 2 (4-point scale; Competency Comments)
questionnaire below. Survey 3 (5-point scale; Competency Comments)
Survey 4 (5-point scale; radio buttons)
In responding to the questions below, think about your experiences Survey 5 (4-point scale; words)
over the last 12 months. The effectiveness of this development tool Survey 6 (4-point scale; words)
is dependent on your honest, forthright and constructive responses Survey 7 (5-point scale; competency comments; N/A)
so please bear this in mind as you answer each question. Your Survey 8 (3-point scale; Agree/Disagree words; N/A)
responses will be aggregated with the responses received from Survey 9 (3-point scale; Strength/Development; N/A)
others. A report will be shared with you at the conclusion of this Survey 10 (Comment boxes only)
project. Survey 11 (Single rating per competency)
Survey 12 (Slide-bar scale)
We Survey 13 (4-point scale; numbers; floating anchors)
Competencies Included: Survey 14 (4-point scale; N/A)
Initiative, Commitment To Result, Conflict Management,
Self Management, Establishing Focus/Direction, Quality,
Problem Solving, Negotiation, Recognition,
Entrepreneurship

encourage everyone to complete the survey. Please be honest,

constructive and thoughtful in your input. The survey is designed to Sample Result Document in PDF format:
help us understand more about your thoughts and needs to make 360-Feedback Results (pdf)
this a great company.

The results of this survey will be used to help drive our future success. We will report back to you about what you have said and what
we plan to do about it. If you have any questions about the process please contact [Contact Person].

Please ensure that your submission is made between November 3 and November 16. The survey will only be available during
these dates.

Thank you for your participation in the survey. We look forward to seeing the analysis of your responses and we are hoping for
100% participation.

Management Team

Needs Could benefit Capable

Significant from and Role
Initiative Improvement Development Effective Model

1. You empower team members to quickly take Needs Could benefit Capable
Role
ownership of problems and propose impactful Significant from and
Model
solutions. Improvement Development Effective

Needs Could benefit Capable

2. You anticipate what needs to be done and makes Role
Significant from and
necessary preparations. Model
Improvement Development Effective
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 Needs Could benefit Capable
Role
3. You take action without being asked. Significant from and
Model
Improvement Development Effective

Needs Could benefit Capable

4. I expand the offerings of the department by working Role
Significant from and
evenings and weekends. Model
Improvement Development Effective

Needs Could benefit Capable

Role
5. I act independently to solve pressing needs. Significant from and
Model
Improvement Development Effective

Needs Could benefit Capable

Significant from and Role
Commitment To Result Improvement Development Effective Model

Needs Could benefit Capable

6. You encourage commitment in others to obtain Role
Significant from and
results. Model
Improvement Development Effective

Needs Could benefit Capable

Role
7. You are committed to the team. Significant from and
Model
Improvement Development Effective

Needs Could benefit Capable

8. You create a sense of urgency among the store team Role
Significant from and
members to complete activities, which drive sales. Model
Improvement Development Effective

Needs Could benefit Capable

9. You are willing to do whatever it takes-not afraid to Role
Significant from and
have to put in extra effort. Model
Improvement Development Effective

Needs Could benefit Capable

Role
10. You take immediate action toward goals. Significant from and
Model
Improvement Development Effective

Needs Could benefit Capable

Significant from and Role
Conflict Management Improvement Development Effective Model

Needs Could benefit Capable

11. I seek to maintain positive relationships with Role
Significant from and
coworkers. Model
Improvement Development Effective

Needs Could benefit Capable

Role
12. You facilitate dialog between team members. Significant from and
Model
Improvement Development Effective

13. I clarify ambiguous situations by asking questions Needs Could benefit Capable
Role
tailored to help others articulate their concerns Significant from and
Model
more precisely. Improvement Development Effective

Needs Could benefit Capable

14. I seeks to have both sides voluntarily work together Role
Significant from and
to resolve their differences. Model
Improvement Development Effective

15. You synthesize input from multiple stakeholders to Needs Could benefit Capable
Role
form a coherent understanding of the conflict Significant from and
Model
landscape. Improvement Development Effective

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 Needs Could benefit Capable
Significant from and Role
Self Management Improvement Development Effective Model

Needs Could benefit Capable

16. You consciously control own negative emotions in Role
Significant from and
order to keep team morale up. Model
Improvement Development Effective

Needs Could benefit Capable

17. You set an example for associates during stressful Role
Significant from and
periods by maintaining a positive, can-do attitude. Model
Improvement Development Effective

18. You deal with conflict by controlling own emotions Needs Could benefit Capable
Role
by listening, being flexible, and sincere in Significant from and
Model
responding. Improvement Development Effective

19. You analyze own reactions on the spot to ensure Needs Could benefit Capable
Role
that communication does not appear to be driven Significant from and
Model
by anger. Improvement Development Effective

Needs Could benefit Capable

20. You do not allow own emotions to interfere with the Role
Significant from and
performance of others. Model
Improvement Development Effective

Needs Could benefit Capable

Significant from and Role
Establishing Focus/Direction Improvement Development Effective Model

Needs Could benefit Capable

21. You prepare daily job and task assignments for Role
Significant from and
employees. Model
Improvement Development Effective

Needs Could benefit Capable

22. I encourage employees to work together for the Role
Significant from and
completion of tasks. Model
Improvement Development Effective

Needs Could benefit Capable

23. I create well articulated goals for the team to Role
Significant from and
pursue. Model
Improvement Development Effective

Needs Could benefit Capable

24. You stay focused even when under pressure and Role
Significant from and
stress. Model
Improvement Development Effective

Needs Could benefit Capable

25. I offer coaching and developmental feedback to Role
Significant from and
help employees navigate challenges. Model
Improvement Development Effective

Needs Could benefit Capable

Significant from and Role
Quality Improvement Development Effective Model

Needs Could benefit Capable

26. You expect employees to produce high quality Role
Significant from and
products. Model
Improvement Development Effective

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 Needs Could benefit Capable
27. You mitigate quality issues before they impact Role
Significant from and
production lines. Model
Improvement Development Effective

Needs Could benefit Capable

28. I regularly measure product specifications to ensure Role
Significant from and
uniformity and quality control. Model
Improvement Development Effective

Needs Could benefit Capable

Role
29. I set benchmarks for quality improvements. Significant from and
Model
Improvement Development Effective

Needs Could benefit Capable

30. You are committed to the improvement of the Role
Significant from and
quality of services and products. Model
Improvement Development Effective

Needs Could benefit Capable

Significant from and Role
Problem Solving Improvement Development Effective Model

Needs Could benefit Capable

31. You resolve production and schedule Role
Significant from and
issues/problems. Model
Improvement Development Effective

Needs Could benefit Capable

Role
32. You are a good problem solver and decision maker. Significant from and
Model
Improvement Development Effective

33. I identify the specific resources required to tackle Needs Could benefit Capable
Role
different aspects of a problem and then assign the Significant from and
Model
resources where they'll have the greatest impact. Improvement Development Effective

Needs Could benefit Capable

34. I establish the sequence of tasks, taking into Role
Significant from and
account dependencies. Model
Improvement Development Effective

Needs Could benefit Capable

35. You prioritize which problems to address issues Role
Significant from and
based on their potential impact on the business. Model
Improvement Development Effective

Needs Could benefit Capable

Significant from and Role
Negotiation Improvement Development Effective Model

Needs Could benefit Capable

36. You are able to decline bad ideas to avoid making Role
Significant from and
poor decisions. Model
Improvement Development Effective

Needs Could benefit Capable

37. I maintain a calm demeanor, even when discussions Role
Significant from and
get heated. Model
Improvement Development Effective

Needs Could benefit Capable

38. I maximize information gathering efforts prior to Role
Significant from and
negotiations. Model
Improvement Development Effective

Needs Could benefit Capable

39. You are successful in making a compelling and Role
Significant from and
influential first offer. Model
Improvement Development Effective

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 Needs Could benefit Capable
40. I control emotional responses to maintain a Role
Significant from and
productive atmosphere. Model
Improvement Development Effective

Needs Could benefit Capable

Significant from and Role
Recognition Improvement Development Effective Model

Needs Could benefit Capable

41. You express genuine appreciation for the work of Role
Significant from and
others. Model
Improvement Development Effective

Needs Could benefit Capable

42. You match the reward to the person being Role
Significant from and
recognized. Model
Improvement Development Effective

Needs Could benefit Capable

43. I create recognition programs that drive Role
Significant from and
improvements in organizational performance. Model
Improvement Development Effective

Needs Could benefit Capable

Role
44. I use recognition as a strategic leadership tool. Significant from and
Model
Improvement Development Effective

Needs Could benefit Capable

45. You are sincerely interested in the suggestions of Role
Significant from and
co-workers. Model
Improvement Development Effective

Needs Could benefit Capable

Significant from and Role
Entrepreneurship Improvement Development Effective Model

Needs Could benefit Capable

Role
46. You take the initiative to complete tasks. Significant from and
Model
Improvement Development Effective

Needs Could benefit Capable

47. You maintain a high level of energy to respond to Role
Significant from and
demands of the job. Model
Improvement Development Effective

Needs Could benefit Capable

48. You exhibit determination and passion in Role
Significant from and
completion of goals. Model
Improvement Development Effective

Needs Could benefit Capable

49. You balance risks and rewards when making Role
Significant from and
decisions. Model
Improvement Development Effective

Needs Could benefit Capable

50. You are comfortable operating in an environment of Role
Significant from and
uncertainty. Model
Improvement Development Effective

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

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

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

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

54. Additional comments, if any for [Participant Name Here]'s assessment.

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