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HR-Survey > 360-Degree Feedback > Competency Model > Achievement Skills

Achievement - 360 Degree Feedback Survey Sample #1

360-Degree Feedback Survey October 2025

Instructions for Employees Participating in the 360-
Feedback Assessment: Questionnaires Measuring Achievement:
Survey 1 (4-point scale; Competency Comments)
[Company] is conducting a 360-Degree Feedback Assessment Survey 2 (4-point scale; Competency Comments)
developed by HR-Survey for selected managers. Survey 3 (5-point scale; Competency Comments)
Survey 4 (5-point scale; radio buttons)
You have been selected to receive feedback from a group of others. Survey 5 (4-point scale; words)
As part of this process, you will need to complete a self-assessment Survey 6 (4-point scale; words)
questionnaire at this time. Your feedback is an important part of our Survey 7 (5-point scale; competency comments; N/A)
company's leadership development process and this survey is Survey 8 (3-point scale; Agree/Disagree words; N/A)
intended to gather broad feedback in the core competencies and Survey 9 (3-point scale; Strength/Development; N/A)
role responsibilities that are important for the on-going success of Survey 10 (Comment boxes only)
our organization. Survey 11 (Single rating per competency)
Survey 12 (Slide-bar scale)
In responding to the questions below, think about your experiences Survey 13 (4-point scale; numbers; floating anchors)
over the last 12 months. The effectiveness of this development tool Survey 14 (4-point scale; N/A)
is dependent on your honest, forthright and constructive responses
so please bear this in mind as you answer each question. Your
responses will be combined with the responses received from others and a report will be generated for you to foster growth and on-
going development.

Partially completed forms can be saved by using the Save/Still Working button at the bottom of the page. You may return at a
later time to complete/edit the form. Your saved responses will be 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.

Sample Result Document: Competencies Included:

Sample Results Achievement, Interpersonal Skills, Coaching,
Entrepreneurship, Action, Continual Learning,
Your feedback is valuable in helping the individual to understand Adaptability, Leadership, Decision Making
how they are perceived and experienced by others and the impact
their behavior has on people in the organization with whom they interact. Feedback received also acknowledges strengths and
identifies areas for development.

Use the form below to provide your feedback. Each field and comment box requires a response before you can SUBMIT your final
feedback.

Please ensure that your submission is made between October 31 and November 13. 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

Achievement Meets
Needs Minimum Is Role
Improvement Standards Proficient Model

1. You set challenging goals for the department.

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 2. I implement standardized processes and procedures to help others
achieve success.

3. You establish stretch goals to advance skills and output.

4. You are flexible in adjusting priorities to meet the demands of

changing situations.

5. You are able to successfully launch the ABC project.

6. You demonstrate a well-organized and timely approach to achieve

desired results

7. You systematically work to improve the organization

8. You are determined to complete tasks regardless of obstacles that

may occur.

9. I operate with relentless drive, consistently meeting and surpassing

deadlines.

If you were to make improvements in Achievement, what are your suggestions for how you can improve this?

Interpersonal Skills Meets

Needs Minimum Is Role
Improvement Standards Proficient Model

10. I appreciate the extra efforts made by coworkers.

11. I am well respected in the department.

12. I pay close attention to what is being communicated verbally and

nonverbally.

13. You are a role model for others demonstrating the importance of
interpersonal skills.

14. You express appreciation of other's work.

15. You display positive interactions.

If you were to make improvements in Interpersonal Skills, what are your suggestions for how you can improve this?

Coaching Meets
Needs Minimum Is Role
Improvement Standards Proficient Model

16. You foster an environment where coaching is considered an integral

part of the corporate culture.

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 17. You provide new ideas and suggestions to stimulate development
and growth.

18. You investigate the issues or hurdles that the employee may be
encountering.

19. I offer coaching when it is needed.

20. You provide challenges that go beyond perceived limitations

21. You help the employee to improve their performance.

If you were to make improvements in Coaching, what are your suggestions for how you can improve this?

Entrepreneurship Meets
Needs Minimum Is Role
Improvement Standards Proficient Model

22. You have clarity of purpose in your actions.

23. You know when to listen to the advice of others.

24. You defy conventions and the "normal" way of doing things.

25. You are excellent at managing relationships with stakeholders.

26. You are motivated to work toward the realization of goals.

27. You exhibit a high sense of self-belief.

If you were to make improvements in Entrepreneurship, what are your suggestions for how you can improve this?

Action Meets
Needs Minimum Is Role
Improvement Standards Proficient Model

28. I create innovative products and services.

29. I fix small issues before they become critical incidents.

30. You adapt your approach in order to overcome significant obstacles.

31. I take action to respond to dissatisfied customers.

32. I delegate decision-making authority to team members.

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 33. You anticipate critical incidents in the department and take steps to
mitigate their effect.

If you were to make improvements in Action, what are your suggestions for how you can improve this?

Continual Learning Meets

Needs Minimum Is Role
Improvement Standards Proficient Model

34. You participate in regular training offered.

35. You pursue self-improvement through continual learning.

36. I view setbacks as opportunities to learn from.

37. You expand your educational and future learning opportunities.

38. You are open to new ideas and concepts.

39. You take charge of your training and skills enhancement.

If you were to make improvements in Continual Learning, what are your suggestions for how you can improve this?

Adaptability Meets
Needs Minimum Is Role
Improvement Standards Proficient Model

40. You adjust plans or schedules to deal with changing situations.

41. I am able to use new features of software applications to analyze

data.

42. You are responsive to the needs of others.

43. You can adjust plans as needed based on changing conditions.

44. I embrace change and foster an open-minded environment.

45. You are able to adjust to changing environments.

If you were to make improvements in Adaptability, what are your suggestions for how you can improve this?

Leadership Meets
Needs Minimum Is Role
Improvement Standards Proficient Model

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 46. You use storytelling to make complex ideas relatable and inspire
action.

47. You meet the developmental needs of subordinates.

48. You align work of employees to a common goal or objective.

49. You encourage calculated risk-taking and treat mistakes as learn

opportunities, not failures.

50. You influence others on your team to reach goals, improve

performance, and try new things

51. I place trust in subordinates to succeed.

If you were to make improvements in Leadership, what are your suggestions for how you can improve this?

Decision Making Meets

Needs Minimum Is Role
Improvement Standards Proficient Model

52. My decision making involves careful analysis of the facts and

consideration of parameters and constraints.

53. I identify which factors can be adjusted and which must remain
constant to guide viable decision paths.

54. You recognize and generates innovative solutions.

55. I integrate multiple dimensions (budget, capacity, morale) into a

holistic evaluation of the costs and benefits.

56. You determine the constraints that may impact what decisions are
acceptable.

57. You have a good rapport other people which is helpful in making
decisions on the team.

If you were to make improvements in Decision Making, what are your suggestions for how you can improve this?

58. What are [Participant Name Here]'s greatest strengths demonstrated this year?

59. What are [Participant Name Here]'s areas for development?

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

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© Copyright 2025, HR-Survey, LLC Legal Notice Web: [Link] Site Map Email: info@[Link]