Feedback Delivery Assessment Form
Assess how feedback is delivered, how useful and clear it feels, and what could improve the experience. Please answer using the exact title “Feedback Delivery Assessment Form” throughout the form.
Respondent Information
Full Name
First Name
Middle Name
Last Name
Role / Job Title
Feedback Delivery Experience
Primary Feedback Channel
*
In-person
Email
Chat/Messaging
Performance Review Meeting
Document/Comment
Other
Frequency of Receiving Feedback
*
Weekly
Monthly
Quarterly
Ad hoc
Other
Overall Feedback Delivery Rating
*
1
2
3
4
5
Clarity and Usefulness Assessment
Rate the feedback on the following aspects
*
Rows
Very Poor
Poor
Fair
Good
Very Good
Clarity
1
2
3
4
5
Specificity
6
7
8
9
10
Timeliness
11
12
13
14
15
Tone
16
17
18
19
20
Actionability
21
22
23
24
25
How useful is the feedback for improvement?
*
Not useful
1
2
3
4
Very useful
5
1 is Not useful, 5 is Very useful
Example of especially clear or unclear feedback
Improvement and Preferences
Preferred improvements to feedback delivery
*
More specific examples
More timely feedback
More balanced feedback
More private delivery
More written follow-up
More discussion time
Other
Additional comments or suggestions
Submit Feedback
Should be Empty: