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HR-Survey > 360-Degree Feedback > Competency Model > Feedback Skills
Feedback - 360 Degree Feedback Survey Sample #2
October 30, 2025
Instructions
Questionnaires Measuring Feedback:
You have been selected to provide feedback on the employee listed Survey 1 (4-point scale; Competency Comments)
above. Your feedback is an important part of our company's Survey 2 (4-point scale; Competency Comments)
leadership development process and this survey is intended to Survey 3 (5-point scale; Competency Comments)
gather broad feedback in the core competencies and role Survey 4 (5-point scale; radio buttons)
responsibilities that are important for the on-going success of our Survey 5 (4-point scale; words)
organization. Survey 6 (4-point scale; words)
Survey 7 (5-point scale; competency comments; N/A)
In responding to the questions below, think about your experiences Survey 8 (3-point scale; Agree/Disagree words; N/A)
working with this employee over the last twelve months and the Survey 9 (3-point scale; Strength/Development; N/A)
goals they were asked to achieve. The effectiveness of this Survey 10 (Comment boxes only)
development tool is dependent on your honest, forthright and Survey 11 (Single rating per competency)
constructive responses so please bear this in mind as you answer Survey 12 (Slide-bar scale)
each question. Your responses will be discussed with the employee Survey 13 (4-point scale; numbers; floating anchors)
to foster growth and on-going development. Survey 14 (4-point scale; N/A)
Competencies Included:
Feedback, Leadership, Persuasion and Influence,
Creativity, Self Management, Passion To Learn,
Delegation, Clarity, Company, Fiscal Management
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 between October 31 and November 13. The survey will only be available during these
dates.
Feedback Capable Could Needs
Clear and Benefit from Significant
Strength Effective Development Improvement
1. Leverages feedback responsibly to enhance professional skills,
ensuring it is applied in a respectful and appropriate manner.
2. Examines patterns in feedback over time to identify recurring themes
or blind spots.
3. Bases feedback on observable facts and behaviors, not personal
opinions or emotions.
4. Equips managers with essential tools, training, and support to
guarantee feedback is constructive, timely, and actionable.
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5. Provides support and resources, such as training programs,
mentorship, or tools, to help employees develop the skills and
knowledge required to implement these changes effectively.
What are your suggestions for how [Participant Name] can make improvements
in Feedback?
Leadership Capable Could Needs
Clear and Benefit from Significant
Strength Effective Development Improvement
6. Recognizes and rewards employees for their accomplishments.
7. Runs efficient and effective meetings with agendas, action items, and
accountabilities clearly spelled out
8. Able to lead the organization.
9. Acts decisively in implementing decisions.
10. Maintains high expectations for performance.
What are your suggestions for how [Participant Name] can make improvements
in Leadership?
Persuasion and Influence Capable Could Needs
Clear and Benefit from Significant
Strength Effective Development Improvement
11. Draws on personal insights to inspire and inform employee choices.
12. Uses public methods of communication to impact the greatest
number of individuals.
13. Stands firm on principles, even when under pressure to compromise
for short-term gain.
14. Able to express own goals and needs.
15. Cultivates advocates for the project to help spread the word through
their peers.
What are your suggestions for how [Participant Name] can make improvements
in Persuasion and Influence?
Creativity Capable Could Needs
Clear and Benefit from Significant
Strength Effective Development Improvement
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16. Synthesizes learned information into innovative designs.
17. Leverages interdepartmental connections to fuel creative solutions.
18. Adapts creative strategies from outside the organization to fit the
team's needs.
19. Inspires creativity in their team.
20. Reflects on new learning to inspire imaginative thinking.
What are your suggestions for how [Participant Name] can make improvements
in Creativity?
Self Management Capable Could Needs
Clear and Benefit from Significant
Strength Effective Development Improvement
21. Deals with conflict by controlling own emotions by listening, being
flexible, and sincere in responding.
22. Sets an example for associates during stressful periods by
maintaining a positive, can-do attitude.
23. Analyzes interpersonal problems instead of reacting to them.
24. Steps away from a situation to process appropriate response.
25. Analyzes own reactions on the spot to ensure that communication
does not appear to be driven by anger.
What are your suggestions for how [Participant Name] can make improvements
in Self Management?
Passion To Learn Capable Could Needs
Clear and Benefit from Significant
Strength Effective Development Improvement
26. Exhibits willingness to upgrade skills through additional training and
education.
27. Takes advantage of training opportunities when they arise.
28. Enjoys learning new skills and techniques.
29. Stays up-to-date on emerging technologies.
30. Is open minded and curious about learning new skills.
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What are your suggestions for how [Participant Name] can make improvements
in Passion To Learn?
Delegation Capable Could Needs
Clear and Benefit from Significant
Strength Effective Development Improvement
31. Offers work that aligns with career aspirations.
32. Allows decisions to be made at the point-of-care.
33. Assesses each employee's strengths and areas of expertise.
34. Optimizes delegation by assigning employees tasks that maximize
efficiency, promote professional development, and enhance
employee engagement.
35. Assigns tasks to subordinates for completion.
What are your suggestions for how [Participant Name] can make improvements
in Delegation?
Clarity Capable Could Needs
Clear and Benefit from Significant
Strength Effective Development Improvement
36. Adjusts communication methods to the needs of the audience.
37. Avoids stating unclear or conflicting goals.
38. Communicates ideas and facts clearly and effectively in writing.
39. Clearly explains the vision and goals of the company.
40. Makes sure goals and objectives are clearly and thoroughly
explained and understood.
What are your suggestions for how [Participant Name] can make improvements
in Clarity?
Company Capable Could Needs
Clear and Benefit from Significant
Strength Effective Development Improvement
41. Works effectively across different departments at the company.
42. Creates a strong sense of camaraderie among colleagues.
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43. Creates a team structure that supports strong collaboration and
communication.
44. Makes a real difference in the communities we serve.
45. Creates flexibility in staffing to adapt to changes.
What are your suggestions for how [Participant Name] can make improvements
in Company?
Fiscal Management Capable Could Needs
Clear and Benefit from Significant
Strength Effective Development Improvement
46. Keeps excellent records for financial transparency.
47. Monitors spending.
48. Develops budgets and plans for various programs and initiatives.
49. Ensures others follow the correct rules and regulations on fiscal
matters.
50. Develops of the department's annual budget.
What are your suggestions for how [Participant Name] can make improvements
in Fiscal Management?
51. Strengths
52. Areas for Development
53. Please give any final comments or suggestions for [Participant Name Here]'s assessment.
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