External Colleague Assessment




Dear Evaluator,


I would appreciate your assistance in completing this 360-degree survey. This survey is being employed as one of many tools in our company’s succession planning process. The purpose of this exercise is to gain insight into the perceptions on my leadership effectiveness and then work to improve any identified areas. You are receiving a modified survey that is seeking information based on your perception of my leadership effectiveness. Hopefully you can answer most of the questions in this survey. Feel free to leave a question blank if you feel you cannot offer a fair perception of my performance. You confidentiality will be maintained as well. Your survey will be populated with other surveys in a general category and the company will use this information in strengthening my leadership effectiveness.


You may return the survey in 3 ways:


1.       Copy the file, save it, complete it, and return by e-mail to

2.       Go to website and follow the instructions

3.       Copy, complete and fax to: (858) 271-5737

4.       Copy and return by mail to: Attn: Lilia Garcia, P.O. Box 261631, San Diego, CA 92196-1631.



The survey is designed for completion in 10 minutes or less. Please return this survey by ________________ Again, thank you in advance for taking time out of your busy schedule to assist me in this worthwhile process. If you have any questions about this survey process, please contact Dr. Larry Bienati at 1-800-483-7153 extension 2.


Thank you. I truly appreciate your candid and constructive feedback.












Ó 2004, Lawrence M. Bienati, Ph.D., All Rights Reserved





Please check the box that best describes your perception of the participant’s demonstrated skill level. If you are unsure how to rate an area then please leave the question blank.


When rating the participant please consider this scale. If the person displays the behavior noted without exception at least 90% of the time, then your rating should be viewed as great performance. If the participant displays the behavior a majority of the time (75% or range greater), then you should rate them as good performance. If the person displays the behavior in a mixed way, some times good, more often than not, then you should rate them as mixed opinion. Finally, if the participant displays this behavior in a small way, then you should rate this as a needs improvement. If you feel you cannot rate the behavior then leave it blank.



Needs Improvement







Conveys a clear sense of Company X’s vision and core values in your personal dealings with him/her.

Systems thinker; has a good grasp of the market and the business environment.

Possesses a strong sense of urgency; self starter

Comes up with fresh perspectives and breakthrough ideas that create value in the marketplace.

Focuses on efforts that add significant value.

Knows how to get things done; responsive to needs of clients.

Creates an environment that promotes teamwork and collaboration when working with industry groups and associations.

Displays a willingness to put needs of __________ and the industry ahead of personal self-interest.

Displays effective problem solving and decision making abilities.

Strategic thinker.

Willing to be decisive if the situation requires immediate action.

Appears to select and retain high caliber staff.

Maintains high standards of personal integrity.

Creates a climate where everyone stretches beyond what they thought they could do.

Ethical in design making.

Behaves in accordance with expressed beliefs and commitments.

Collaborates as a team player; never undermines others for own gain.

Reliable; can be counted on to follow through on commitments.

Treats others fairly and consistently.

Expresses ideas clearly and concisely in various communication situations.

Expresses opinions effectively without intimidating others.

Listens carefully to input and feedback with appropriate sensitivity to the person.

Encourages others to express contrary views.

Projects self-assurance and unshakable confidence.

Maintains a sense of humor.

Readily shares credit and gives opportunities for visibility to others.

Seeks and accepts constructive criticism.

Composed, positive, unflappable in trying moments.

Willing to admit own mistakes.

Operates on an expectation of success rather than fear of failure.

Results oriented; has a strong drive to achieve goals and objectives.

Is effective in personally developing and maintaining client and peer relationships.

QUESTIONS (Continued)

Needs Improvement







Committed to delivering high quality work consistent with Company X’s core values.

Models the way with effective loss prevention practices consistent with the standards of practice.

Willing to challenge the process and express contrary views if situation requires it.

Listens well; willing to solicit feedback from clients and others, as situation requires.



1.         In what capacity have you observed PARTICIPANT’S leadership effectiveness?





2.         Based on your working relationship with PARTICIPANT what do you appreciate about his/her leadership effectiveness?





3.         What can PARTICIPANT do to improve his leadership effectiveness?





4.         What value have you gained in your relationship with PARTICIPANT?




5.         How is PARTICIPANT perceived external to the ______________ organization? What can he do more of? Less of?




6.         Is there anything else you woke like to add in our efforts to strengthen PARTICIPANT’S leadership effectiveness in improving the delivery of services to your organization?




7.         Optional: What words would best describe PARTICIPANT?