360 Feedback Assessment

This is an example of a 360 Feedback Assessment survey. This questionnaire can be used as part of a 360-Feedback assessment process.


As part of the leadership development process, you will need to assess your performance using this 360 Feedback Assessment. This self-assessment will be compared to the feedback you will receive from your manager. Feedback is an important part of our leadership development process and this survey is intended to gather feedback in the core competencies and role responsibilities that are important for your success and the on-going success of our organization.

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.

To make plenty of room for challenging this individual to grow as well as to enable us to measure future growth, please fully utilize the following top-loaded rating scale:

  • Superlative: consistently stretches my idea of what is possible in this behavior or capacity
  • Truly excellent: degree of mastery that meets my highest expectations
  • Very good: consistently demonstrates strong capacity
  • Good: exceeds the minimum I consider adequate for the personís role
  • Fair: minimum degree I consider adequate for the personís role
  • Poor: falls below degree I consider adequate for the personís role
  • Very poor: very low capacity or infrequently demonstrated behavior

  1. Considers customers point of view when making decisions.
  2. Is effective in satisfying customer needs.
  3. Develops strong customer relationships.
  4. Maintains communication with customers.
  5. Responds to customer objectives and needs.
  6. Ensures that the customer's needs receive primary focus.
  7. Responds quickly to customer problems and needs.
  8. Looks beyond company for new ideas and innovative approaches.
  9. Builds upon the ideas and solutions of others.
  10. Develops effective solutions for viewing problems from a different point of view.
  11. Identifies fresh approaches to solving problems.
  12. Pursues innovative approaches to the current policies and procedures.
  13. Establishes systems of continuous improvement.
  14. Creates innovative products or services.
  15. Encourages collaboration of fellow employees to achieve results.
  16. Creates a culture that fosters and values collaboration.
  17. Identifies and resolves conflicts within the team to increase team effectiveness
  18. Facilitates team-building within the leadership team
  19. Seeks and listens to other's contributions
  20. Facilitates team discussions and problem-solving
  21. Fosters respect and understanding among team members
  22. Discusses with team about issues and the effects of those issues.
  23. Actively participates as a team member
  24. Fosters a high standard of ethics and integrity.
  25. Does the right thing even when negative consequence may result.
  26. Maintains strong relationships with others.
  27. Establishes relationships of trust, honesty, fairness, and integrity.
  28. Demonstrates honesty and truthfulness at all times.
  29. Develops trust and confidence from others.
  30. Maintains the confidentiality of others.
  31. Accepts responsibility for mistakes.
  32. Conducts all dealings in an honest and upfront manner.
  33. Implements and uses performance measures.
  34. Works effectively in the department.
  35. Encourages others to increase their job performance.
  36. Listens and responds to issues and problems
  37. Sets a high standard for job performance.
  38. Effectively organizes resources and plans
  39. Uses agendas when chairing or facilitating meetings.
  40. Focuses on tasks that have high priority.
  41. Works quickly when faced with difficult problems.
  42. Makes effective decisions, even when under pressure
  43. Assigns tasks and responsibilities to develop skills of others.
  44. Creates opportunities for professional development.
  45. Supports the successes of other employees.
  46. Assesses employees' developmental needs.
  47. Provides constructive feedback to others.
  48. Conducts regular reviews to explore development opportunities.
  49. Recognizes and celebrates accomplishments of others.
  50. Gives inspiring presentations or discussions.
  51. Volunteers to participate on special projects, teams, or events.
  52. Empowers others to achieve results and holds them accountable for actions.
  53. Acts decisively in implementing decisions.
  54. Influences the work of employees within the department.
  55. Keeps subordinates informed.
  56. Provides individual coaching for employees as needed.

  57. Final Comments

    In the spaces provided below, please type in any comments/feedback about yourself that you believe are relevant to your development.

    The following starter questions are provided to help trigger your feedback comments. Think of your interaction with over the course of the year and the extent to which realized objectives through people management, budget management, interpersonal relationships and other factors.

    1. In what ways contributed to our success and/or departmental goals / initiatives? Is there anything that stands out in particular or specific examples worth mentioning?
    2. What were your disappointments relative to "misses"Ě if any this year? Specific examples?
    3. What competencies were demonstrated at a higher than expected level? Examples?
    4. What competencies represent developmental opportunities? Examples?
    5. Any other thoughts?

    Greatest Strengths

    Areas for Development

Status of the Form

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