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HR-Survey > 360-Degree Feedback > Competency Model > Goals
Goals - 360 Degree Feedback Survey Sample #4
November 2, 2025
Dear Employee:
Questionnaires Measuring Goals:
Survey 1 (4-point scale; Competency Comments)
Welcome to our 360-Degree Feedback Assessment of [Participant Survey 2 (4-point scale; Competency Comments)
Name]. Our objective is to provide feedback which will help Survey 3 (5-point scale; Competency Comments)
advance his/her leadership skills and capabilities. We are asking you Survey 4 (5-point scale; radio buttons)
to take time to respond to this survey to help us identify where we Survey 5 (4-point scale; words)
are doing well and where we have opportunities to do better. Survey 6 (4-point scale; words)
Survey 7 (5-point scale; competency comments; N/A)
We have developed this survey with questions tailored for Survey 8 (3-point scale; Agree/Disagree words; N/A)
[Participant Name]'s position in the department to provide you Survey 9 (3-point scale; Strength/Development; N/A)
with an opportunity to anonymously rate many facets of his/her Survey 10 (Comment boxes only)
leadership performance. The survey will assess what you value most Survey 11 (Single rating per competency)
in their leadership skills and allow you to make positive suggestions Survey 12 (Slide-bar scale)
for improvement. Survey 13 (4-point scale; numbers; floating anchors)
Survey 14 (4-point scale; N/A)
Competencies Included:
Goals, Commitment To Result, Safety, Responsible,
Negotiation, Adaptability, Bias for Action, Cultural
Awareness, Analytical, Initiative, Innovation,
Please be honest, constructive and thoughtful in your responses. The
results of this survey will be used to help drive our future success. If Sample Result Document:
you have any questions about the process please contact [Contact Sample Results
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
Instructions:
Please complete the items below and press the submit button at the end of the survey. If you need multiple sessions to complete the
survey, please click the "Submit" button at the end of each session to save your responses. Please feel free to skip any items that you
do not wish to respond to. Keep in mind that your responses help us to become a better place to work. So, you are encouraged to
respond to all items on the questionnaire.
Needs Capable
Significant and Role
Goals Development Effective Model
1 2 3 4 5
1. Gives helpful feedback and lends support to coworkers
in reaching their goals.
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2. Monitors progress regularly to assess that the goal is
still on track.
3. Recognizes each person's strengths and needs to foster
a collaborative environment for achieving shared goals.
4. Possesses a clear understanding of the evaluation
criteria used to measure performance against the
established goals for the position.
5. Delivers productive feedback and extends help to peers
to accomplish their goals.
Needs Capable
Significant and Role
Commitment To Result Development Effective Model
1 2 3 4 5
6. Coordinates all department activities into a cohesive
team effort.
7. Maintains persistence and dedication to achieving
results.
8. Creates a sense of urgency among the store team
members to complete activities, which drive sales.
9. Willing to do whatever it takes-not afraid to have to put
in extra effort.
10. Encourages commitment in others to obtain results.
Needs Capable
Significant and Role
Safety Development Effective Model
1 2 3 4 5
11. Develops a strong safety culture.
12. Develops a sustainable safety culture.
13. Is not afraid to question a potential safety issue
observed in the workplace.
14. Works to implement corrective safety measures.
15. Develops safety guidelines for the department.
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Needs Capable
Significant and Role
Responsible Development Effective Model
1 2 3 4 5
16. Works in a way that makes others want to work with
her/him.
17. Holds herself / himself accountable to goals /
objectives
18. Sets a good example
19. ...takes personal responsibility for results.
20. Sets high personal standards of performance.
Needs Capable
Significant and Role
Negotiation Development Effective Model
1 2 3 4 5
21. Is resolute in positions to better withstand pressure and
resist making hasty concessions.
22. Justifies viewpoints using strong and credible data.
23. Clearly articulates points and actively listens to the
others to ensure that both sides understand each
other's needs and concerns.
24. Stays focused and avoids getting sidetracked by less
important issues.
25. Maintains communication channels between parties in
the negotiation.
Needs Capable
Significant and Role
Adaptability Development Effective Model
1 2 3 4 5
26. Adjusts plans or schedules to deal with changing
situations.
27. Flexible and adaptable when confronted with
unexpected changes.
28. Adapts to novel, dynamic, and changing situations
requiring creative solutions to new problems.
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29. Alters strategic plans based on new information.
30. Able to step in and help co-workers when needed.
Needs Capable
Significant and Role
Bias for Action Development Effective Model
1 2 3 4 5
31. Starts work on projects without having to be told.
32. Encourages risk taking and experimentation to improve
performance
33. Positively motivates and supports others to gain skills
34. Conducts a thorough risk assessment at the start of the
project to identify potential issues that could arise.
35. Addresses any problems immediately before its too
late.
Needs Capable
Significant and Role
Cultural Awareness Development Effective Model
1 2 3 4 5
36. Participates in or facilitates cultural sensitivity training
for self and team.
37. Recognizes how cultural context influences employee
motivation, communication, and collaboration.
38. Demonstrates humility when learning about unfamiliar
cultural customs or beliefs.
39. Open to learning about different cultures.
40. Promotes culturally respectful partnerships with
external stakeholders and global teams.
Needs Capable
Significant and Role
Analytical Development Effective Model
1 2 3 4 5
41. Creates detailed budgets that guide financial planning
and decision-making.
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42. Audits financial records to detect fraud or errors.
43. Utilizes data and logical reasoning to address and
challenge personal biases in decision-making.
44. Reduces issues to their fundamental elements.
45. Organizes data in a way that simplifies its interpretation
and comparisons.
Needs Capable
Significant and Role
Initiative Development Effective Model
1 2 3 4 5
46. Initiates new projects for the department.
47. Analyzes the needs of the situation and acts before
being told to do so.
48. Begins a task and follows through until completion.
49. Creates solutions to problems as soon as an incident
occurs.
50. Helps the department take the initiative to create new
solutions.
Needs Capable
Significant and Role
Innovation Development Effective Model
1 2 3 4 5
51. Solves problems with insight and understanding.
52. I provide the necessary support and resources to
empower employees to develop and implement
innovative ideas.
53. Looks for new ways of doing things.
54. Creates new products or services.
55. Focuses on creating new value for our
products/services.
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56. On a scale of Excellent to Poor, how would you rate your overall employment with [Company] and why?
-Excellent
-Good
-Average
-Poor
57. Would you refer others who are seeking employment to [Company]?
Yes No
Please provide explanation:
58. If you had an opportunity to make any change you wanted to make [Company] a better place to work, what one
improvement would you make?
59. What changes do you see [Company] making in order to raise the standards?
60. I feel good about my continued employment with [Company].
Yes No
If no, please provide explanation:
61. What do you like best about working for [Company]?
62. What do you like least about working for [Company]? How could it be improved?
93. Use the space below to enter any final comments you would like to be noted:
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